Provider Demographics
NPI:1467702175
Name:JOAN D OLEARY MD PL
Entity Type:Organization
Organization Name:JOAN D OLEARY MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:OLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-278-3100
Mailing Address - Street 1:1555 KINGSLEY AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4560
Mailing Address - Country:US
Mailing Address - Phone:904-278-3100
Mailing Address - Fax:904-278-4463
Practice Address - Street 1:1555 KINGSLEY AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4560
Practice Address - Country:US
Practice Address - Phone:904-278-3100
Practice Address - Fax:904-278-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64412207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18934BOtherPTAN