Provider Demographics
NPI:1841210747
Name:O'LEARY, EDWARD T (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:T
Last Name:O'LEARY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:#334
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-941-4845
Mailing Address - Fax:480-994-3058
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:#334
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-941-4845
Practice Address - Fax:480-994-3058
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-02-17
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Provider Licenses
StateLicense IDTaxonomies
AZ34329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI41533Medicare UPIN