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General NPI Number Information
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NPI Number | 1861457582
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Entity Type | Individual
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Provider Name | BRENDAN DOMINIC OCONNOR MD
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Gender | Male
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Dates
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Enumeration Date | 04/18/2006
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 115 NORTHSHORE BLVD
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City | PORTLAND
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State | TX
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Zip | 78374
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Country | US
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Telephone | 361-777-1777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1888
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City | GREENVILLE
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State | TX
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Zip | 75403
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Country | US
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Telephone | 800-945-2455
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Fax | 903-453-2541
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | J3864
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License Number State | TN
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