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General NPI Number Information
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NPI Number | 1669932513
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Entity Type | Individual
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Provider Name | CONNOR BLAINE VENRICK MD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2019
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 2817 ROCK MERRITT AVE STOP A
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City | FORT BRAGG
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State | NC
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Zip | 28310-1109
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Country | US
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Telephone | 303-475-7759
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Fax |
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Provider Business Mailing Address
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Address Line | 2817 ROCK MERRITT AVE STOP A
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City | FORT BRAGG
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State | NC
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Zip | 28310-0001
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Country | US
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Telephone |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 36052
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD21363
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License Number State | HI
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