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General NPI Number Information
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NPI Number | 1841644358
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Entity Type | Organization
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Legal Business Name | JEREMY D. MCCONNELL, MD, PA
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 11/19/2021
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Provider Practice Location Address
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Address Line | 5717 21ST AVE W
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City | BRADENTON
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State | FL
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Zip | 34209
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Country | US
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Telephone | 941-792-8383
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Fax | 941-792-8484
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Provider Business Mailing Address
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Address Line | 5717 21ST AVE W
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City | BRADENTON
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State | FL
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Zip | 34209
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Country | US
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Telephone | 941-792-8383
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Fax | 941-792-8484
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEREMY DAVID MCCONNELL
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Credential | MD
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Telephone | 813-404-0159
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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 | ME83356
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number | ME83356
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207QS1201X
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Taxonomy Name | Sleep Medicine (Family Medicine) Physician
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License Number | ME83356
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License Number State | FL
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