Organization
DR GERARD O'HALLORAN ENT & FACIAL PLASTIC SURGERY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERARD L O'HALLORAN MD (PRESIDENT)
(612) 590-0175
Entity
Organization
Contact information
Practice address
1645 LYNDALE AVE N, SUITE 3, FARIBAULT, MN 55021-2934
(612) 590-0175
(651) 493-0968
Mailing address
5133 SHERIDAN AVE S, MINNEAPOLIS, MN 55410-2238
(612) 590-0175
(651) 493-0968
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
30984
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
040000375
—
MN
Enumeration date
11/07/2010
Last updated
11/07/2010
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