Provider Demographics
NPI:1114358959
Name:O'HARA, JAY
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:O'HARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HILLVIEW RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:NY
Mailing Address - Zip Code:14883-9685
Mailing Address - Country:US
Mailing Address - Phone:505-235-7076
Mailing Address - Fax:
Practice Address - Street 1:4502 APPALOOSA CRST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-4960
Practice Address - Country:US
Practice Address - Phone:505-235-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-04
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant