Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | ME67867 | FL |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME0067867 | FL |
NPI | 1194723643 |
---|---|
Provider Name | Nicholas J Connors |
First Address | Port Charlotte, FL 33948-1042 |
Second Address | Port Charlotte, FL 33948-1042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 29/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
257697000 | (05) | FL |
68789 | BCBS (01) | FL |
G26428 | (02) |