Healthcare Provider Details

I. General information

NPI: 1255309712
Provider Name (Legal Business Name): ELIZABETH J MCCONNELL MD PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 05/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 N 16TH ST
PHOENIX AZ
85016-1706
US

IV. Provider business mailing address

6245 N 16TH ST
PHOENIX AZ
85016-1706
US

V. Phone/Fax

Practice location:
  • Phone: 602-253-4271
  • Fax: 602-253-4273
Mailing address:
  • Phone: 602-253-4271
  • Fax: 602-253-4273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH J MCCONNELL
Title or Position: PRESIDENT
Credential: MD
Phone: 602-253-4271