Healthcare Provider Details

I. General information

NPI: 1790748648
Provider Name (Legal Business Name): WILLIAM T. CONNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE STREET ROOM 283
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

3117 WEYMOUTH CT
LEXINGTON KY
40509-2377
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6679
  • Fax:
Mailing address:
  • Phone: 859-219-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number20533
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: