Healthcare Provider Details

I. General information

NPI: 1932861168
Provider Name (Legal Business Name): CHRISTOPHER JAMES O'CONNOR PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S MAYS ST STE 201
ROUND ROCK TX
78664-7580
US

IV. Provider business mailing address

101 W LOUIS HENNA BLVD STE 300
AUSTIN TX
78728-1203
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-4272
  • Fax: 512-244-2895
Mailing address:
  • Phone: 512-492-3743
  • Fax: 512-593-4444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15512
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: