Provider Demographics
NPI:1750441580
Name:O'HEARNE, JOHN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:O'HEARNE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1017 LARAMIE BLVD
Mailing Address - Street 2:6D
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4724
Mailing Address - Country:US
Mailing Address - Phone:720-406-7581
Mailing Address - Fax:720-406-7584
Practice Address - Street 1:1823 FOLSOM ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5746
Practice Address - Country:US
Practice Address - Phone:720-406-7581
Practice Address - Fax:720-406-7584
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CO32119207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA65185Medicare UPIN