Healthcare Provider Details

I. General information

NPI: 1578068102
Provider Name (Legal Business Name): CONNER OWEN BLACKWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 6258
DAYTON OH
45409-2939
US

IV. Provider business mailing address

1071 DAPPLE CT
FAIRBORN OH
45324-8772
US

V. Phone/Fax

Practice location:
  • Phone: 937-245-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.146641
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number111505
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: