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General NPI Number Information
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NPI Number | 1215987227
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Entity Type | Individual
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Provider Name | MARILYN J CONNORS D.O.
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Gender | Female
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 609 N CAROL MALONE BLVD
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City | GRAYSON
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State | KY
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Zip | 41143-1123
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Country | US
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Telephone | 606-474-7892
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Fax | 606-474-0040
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Provider Business Mailing Address
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Address Line | PO BOX 1595
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City | ASHLAND
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State | KY
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Zip | 41105-1595
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Country | US
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Telephone | 606-408-4000
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 231855
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1103
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 03296
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License Number State | KY
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