Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 22502 | AZ |
NPI | 1003848227 |
---|---|
Provider Name | Dr. David Connor |
First Address | Oak Brook, IL 60523-1804 |
Second Address | Glendale, AZ 85306-4622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 18/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E81725 | (02) | AZ |