MEDICARE: CONNOR J GORMAN PA-C

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	7057360001	AZ
2	332B00000X	Durable Medical Equipment & Medical Supplies	70349500001	AZ
3	332B00000X	Durable Medical Equipment & Medical Supplies	7209350001	AZ
4	332B00000X	Durable Medical Equipment & Medical Supplies	7046960001	AZ
5	332B00000X	Durable Medical Equipment & Medical Supplies	7047150001	AZ
6	332B00000X	Durable Medical Equipment & Medical Supplies	7939960001	AZ
7	332B00000X	Durable Medical Equipment & Medical Supplies	7629170001	AZ
8	332B00000X	Durable Medical Equipment & Medical Supplies	8220410001	AZ
9	363AM0700X	Medical Physician Assistant	9559	AZ
10	332B00000X	Durable Medical Equipment & Medical Supplies	704516001	AZ

NPI Number	:	1851000731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR J GORMAN PA-C

Provider Business Mailing Address
First Line	:	1839 S ALMA SCHOOL RD STE 354
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-3028
Country	:	US
Telephone Number	:	480-726-2287
Fax Number	:	888-503-3312

Provider Business Practice Location Address
First Line	:	20860 N TATUM BLVD STE 290
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-4282
Country	:	US
Telephone Number	:	480-563-1144
Fax Number	:	480-563-2371

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

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	07/17/2023