Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 303 | OK |
NPI | 1083785091 |
---|---|
Provider Name | Dr. Gregory A Conner |
First Address | Charlottesville, VA 22901 |
Second Address | Charlottesville, VA 22901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 18/06/2013 |