Healthcare Provider Details

I. General information

NPI: 1013055623
Provider Name (Legal Business Name): MICHAEL FRANCIS O'CONNELL PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2007
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 CARDLEY AVE
MEDFORD OR
97504-6124
US

IV. Provider business mailing address

728 CARDLEY AVE
MEDFORD OR
97504-6124
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-4077
  • Fax: 541-773-3621
Mailing address:
  • Phone: 541-773-4077
  • Fax: 541-773-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number452
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: