Provider Demographics
NPI:1841290509
Name:OMEARA, PATRICK MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:MICHAEL
Last Name:OMEARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:255 N ELM ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3431
Mailing Address - Country:US
Mailing Address - Phone:760-743-0100
Mailing Address - Fax:760-743-1414
Practice Address - Street 1:255 N ELM ST
Practice Address - Street 2:STE105
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3431
Practice Address - Country:US
Practice Address - Phone:760-743-0100
Practice Address - Fax:760-743-1414
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2010-02-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG66518207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F11804Medicare UPIN