Healthcare Provider Details

I. General information

NPI: 1699888677
Provider Name (Legal Business Name): WILLIAM F O'CONNOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

IV. Provider business mailing address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

V. Phone/Fax

Practice location:
  • Phone: 724-773-4621
  • Fax: 724-773-4696
Mailing address:
  • Phone: 724-773-4621
  • Fax: 724-773-4696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD019678E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: