Provider Demographics
NPI:1336121565
Name:O'LEARY, JACQUELINE G (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:G
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3410 WORTH ST
Mailing Address - Street 2:SUITE 860
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2003
Mailing Address - Country:US
Mailing Address - Phone:214-820-8500
Mailing Address - Fax:214-820-0993
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:SUITE 860
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-820-8500
Practice Address - Fax:214-820-0993
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2514207RG0100X, 207RI0008X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1848467-04Medicaid