Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 11683 | PR |
NPI | 1154388742 |
---|---|
Provider Name | Dr. Owen Gerard Connelly |
First Address | Hato Rey, PR 00936 |
Second Address | Hato Rey, PR 00936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2006 |
Last Update Date | 02/04/2019 |