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General NPI Number Information
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NPI Number | 1013190602
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Entity Type | Organization
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Legal Business Name | JERRY W CONNERS MD PSC
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 12/06/2007
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Provider Practice Location Address
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Address Line | 40 NORTH GRAND AVENUE SUITE 200
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City | FT THOMAS
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State | KY
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Zip | 41075
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Country | US
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Telephone | 859-781-2700
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Fax | 859-781-2712
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Provider Business Mailing Address
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Address Line | 40 NORTH GRAND AVENUE SUITE 200
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City | FT THOMAS
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State | KY
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Zip | 41075
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Country | US
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Telephone | 859-781-2700
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Fax | 859-781-2712
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Authorized Official
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Title or Position | MD
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Name | JERRY W CONNERS
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Credential | MD
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Telephone | 859-781-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 15481
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License Number State | KY
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