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General NPI Number Information
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NPI Number | 1063440121
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Entity Type | Individual
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Provider Name | ELLEN J O'CONNELL MD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 500 W MAIN ST
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City | LEWISVILLE
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State | TX
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Zip | 75057-3629
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Country | US
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Telephone | 972-420-1576
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Fax |
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Provider Business Mailing Address
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Address Line | 4034 RAWLINS ST APT 106
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City | DALLAS
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State | TX
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Zip | 75219-5632
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Country | US
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Telephone | 214-252-0490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | L9831
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License Number State | TX
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