Healthcare Provider Details

I. General information

NPI: 1922787258
Provider Name (Legal Business Name): CONNOR JAMES MCINTYRE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2023
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 204
PHOENIX AZ
85004-1844
US

IV. Provider business mailing address

3025 E ROOSEVELT ST
PHOENIX AZ
85008-5033
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-6550
  • Fax:
Mailing address:
  • Phone: 435-671-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9794
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: