Provider Demographics
NPI:1922169663
Name:O'HARE, BRADY JAMES (MD)
Entity Type:Individual
Prefix:
First Name:BRADY
Middle Name:JAMES
Last Name:O'HARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3484
Mailing Address - Country:US
Mailing Address - Phone:308-865-2141
Mailing Address - Fax:308-865-2151
Practice Address - Street 1:211 W 33RD ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-3484
Practice Address - Country:US
Practice Address - Phone:308-865-2141
Practice Address - Fax:308-865-2151
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery