Provider Demographics
NPI:1639215866
Name:O'MEARA, PATRICK D (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:D
Last Name:O'MEARA
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:PO BOX 2055
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81402
Mailing Address - Country:US
Mailing Address - Phone:970-240-3775
Mailing Address - Fax:970-240-3777
Practice Address - Street 1:330 SOUTH 9TH STREET
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401
Practice Address - Country:US
Practice Address - Phone:970-240-3775
Practice Address - Fax:970-240-3777
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01305457Medicaid
COC5292Medicare ID - Type Unspecified
CO01305457Medicaid