Healthcare Provider Details

I. General information

NPI: 1467542688
Provider Name (Legal Business Name): ROBERT ALAN CONNOR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 C TREE RD
MCALESTER OK
74501-9002
US

IV. Provider business mailing address

1 C TREE RD OCC. HEALTH CLINIC
MCALESTER OK
74501-9002
US

V. Phone/Fax

Practice location:
  • Phone: 918-420-7594
  • Fax:
Mailing address:
  • Phone: 918-420-7594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License NumberR0032618
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: