Provider Demographics
NPI:1275767626
Name:O'HARE, JACQUELINE TRAM (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:TRAM
Last Name:O'HARE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:TRAM
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:P.O. BOX 910
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-0910
Mailing Address - Country:US
Mailing Address - Phone:713-500-5301
Mailing Address - Fax:713-500-0732
Practice Address - Street 1:5656 KELLEY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-1967
Practice Address - Country:US
Practice Address - Phone:713-566-5100
Practice Address - Fax:713-566-5106
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8211207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology