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General NPI Number Information
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NPI Number | 1235642497
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Entity Type | Individual
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Provider Name | MICHAEL EUGENE CONNER III RN
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Gender | Male
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 921 NE 13TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-5007
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Country | US
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Telephone | 405-456-5607
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 S ELLISON AVE
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City | EL RENO
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State | OK
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Zip | 73036-5322
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Country | US
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Telephone | 405-200-9579
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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 | 1710I1003X
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Taxonomy Name | Independent Duty Medical Technicians
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 146M00000X
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Taxonomy Name | Intermediate Emergency Medical Technician
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License Number | 28283
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 126799
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License Number State | OK
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