Provider Demographics
NPI:1376598995
Name:O'LEARY, ANDREW W (DO)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:W
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3343 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8002
Practice Address - Country:US
Practice Address - Phone:561-795-9845
Practice Address - Fax:561-795-8791
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH340066422085R0001X
MS281202085R0001X
FLOS81882085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7841172OtherAETNA
FL016656600Medicaid
FLP1034697OtherFREEDOM
OH0207207Medicaid
FL272245OtherAVMED
FL1242207OtherWELLCARE MEDICARE ONLY
OH2797880Medicaid
FLP970567OtherOPTIMUM
FL51677OtherBCBS
FLP01560759OtherRR MEDICARE
FL14361OtherDIMENSION
FLP01560759OtherRR MEDICARE
FL516770Medicare PIN
OH9288885Medicare PIN
OH4182192Medicare PIN