Healthcare Provider Details

I. General information

NPI: 1801887864
Provider Name (Legal Business Name): WILLIAM CHANCE CONNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W 40TH ST
AUSTIN TX
78756-4010
US

IV. Provider business mailing address

1010 W 40TH ST
AUSTIN TX
78756-4010
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-8753
  • Fax: 512-651-8441
Mailing address:
  • Phone: 512-459-8753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberM2291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: