MEDICARE: MR. CRAIG W CONNOR PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1213	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215923206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CRAIG W CONNOR PA-C

Provider Business Mailing Address
First Line	:	560 N CAMINO MERCADO
Second Line	:	SUITE 7
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5759
Country	:	US
Telephone Number	:	520-836-5538
Fax Number	:	520-836-6998

Provider Business Practice Location Address
First Line	:	560 N CAMINO MERCADO
Second Line	:	SUITE 7
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5759
Country	:	US
Telephone Number	:	520-836-5538
Fax Number	:	520-836-6998

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	02/23/2010

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