Individual
ALFRED W. O'DAIRE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
511 BELFIELD DR., EMPORIA, VA 23847
(434) 348-4680
(434) 336-0014
Mailing address
511 BELFIELD DR., EMPORIA, VA 23847
(434) 348-4680
(434) 336-0014
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110840276
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1831184803
—
VA
01
—
P00376918
RR MEDICARE
—
Enumeration date
09/15/2005
Last updated
09/04/2012
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