Healthcare Provider Details

I. General information

NPI: 1679507198
Provider Name (Legal Business Name): PATRICK J O'CONNOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 S J STOCK RD
TUCSON AZ
85746-7012
US

IV. Provider business mailing address

839 W CONGRESS ST
TUCSON AZ
85745-2819
US

V. Phone/Fax

Practice location:
  • Phone: 520-295-2406
  • Fax: 520-295-2602
Mailing address:
  • Phone: 520-792-9890
  • Fax: 520-884-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28955
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42989
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: