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NPI Code Detail

MEDICARE: JERRY W CONNERS MD PSC

MEDICARE: JERRY W CONNERS MD PSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician15481KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013190602
Entity Type Code : Organization
Provider Name (Legal Business Name) : JERRY W CONNERS MD PSC
Provider Business Mailing Address
First Line : 40 NORTH GRAND AVENUE
Second Line : SUITE 200
City : FT THOMAS
State : KY
Zip : 41075
Country : US
Telephone Number : 859-781-2700
Fax Number : 859-781-2712
Provider Business Practice Location Address
First Line : 40 NORTH GRAND AVENUE
Second Line : SUITE 200
City : FT THOMAS
State : KY
Zip : 41075
Country : US
Telephone Number : 859-781-2700
Fax Number : 859-781-2712
Authorized Official
Title or Position : MD
Name : JERRY W CONNERS
Credential : MD
Telephone Number : 859-781-2700
Provider Enumeration Date : 12/06/2007
Last Update Date : 12/06/2007

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Directions to “JERRY W CONNERS MD PSC ” Practice Location

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