Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 530196961 | DC |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | C1-0009837 | DE |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | C7-0004483 | DE |
NPI | 1639333107 |
---|---|
Provider Name | Justin R Connor |
First Address | Dover, DE 19904-4141 |
Second Address | Dover, DE 19904-4141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2008 |
Last Update Date | 10/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201159650A | (05) | KS |
250499212 | (05) | DE |