Healthcare Provider Details

I. General information

NPI: 1902225402
Provider Name (Legal Business Name): DAVID THOMAS CONNOLLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2014
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 PARK ST
SEMINOLE FL
33777-4632
US

IV. Provider business mailing address

6900 TAVISTOCK LAKES BLVD STE 300
ORLANDO FL
32827-7592
US

V. Phone/Fax

Practice location:
  • Phone: 727-397-1559
  • Fax: 727-391-0838
Mailing address:
  • Phone: 321-332-6947
  • Fax: 407-313-3081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1590
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: