Healthcare Provider Details

I. General information

NPI: 1437101052
Provider Name (Legal Business Name): GERARD A O'CONNOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6716 NW 11TH PL
GAINESVILLE FL
32605-4215
US

IV. Provider business mailing address

6716 NW 11TH PL
GAINESVILLE FL
32605-4215
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-9729
  • Fax: 352-331-0136
Mailing address:
  • Phone: 352-331-9729
  • Fax: 352-331-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME40165
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: