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NPI Code Detail

MEDICARE: DR. JEREMY MCCONNELL M.D.

MEDICARE: DR. JEREMY MCCONNELL M.D.
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
1207Q00000XFamily Medicine PhysicianME83356FL
2207QB0002XObesity Medicine (Family Medicine) PhysicianME83356FL
3207QS1201XSleep Medicine (Family Medicine) PhysicianME83356FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21700871969OTHERFLNPI

General Provider Information

NPI Number : 1700871969
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEREMY MCCONNELL M.D.
Provider Business Mailing Address
First Line : 5717 21ST AVE WEST
Second Line :
City : BRADENTON
State : FL
Zip : 34209
Country : US
Telephone Number : 941-792-8383
Fax Number : 941-792-8484
Provider Business Practice Location Address
First Line : 5717 21ST AVE WEST
Second Line :
City : BRADENTON
State : FL
Zip : 34209
Country : US
Telephone Number : 941-792-8383
Fax Number : 941-792-8484
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 11/29/2021

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