Healthcare Provider Details

I. General information

NPI: 1568576205
Provider Name (Legal Business Name): GARY J CONNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST SUITE 4130
DAYTON OH
45409-2722
US

IV. Provider business mailing address

5100 SPRINGFIELD ST SUITE 400
DAYTON OH
45431-1261
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6810
  • Fax: 937-222-7255
Mailing address:
  • Phone: 937-259-9900
  • Fax: 937-259-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD024974E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number20076
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: