Healthcare Provider Details

I. General information

NPI: 1912087321
Provider Name (Legal Business Name): TERESIA O'CONNOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST
HOUSTON TX
77030-2316
US

IV. Provider business mailing address

6701 FANNIN ST
HOUSTON TX
77030-2316
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-2778
  • Fax: 832-825-4347
Mailing address:
  • Phone: 832-822-2778
  • Fax: 832-825-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL5493
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: