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NPI Code Detail

MEDICARE: DR. GREGORY A CONNELL M.D.

MEDICARE: DR. GREGORY A CONNELL M.D.
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
1174400000XSpecialistWA
2207L00000XAnesthesiology PhysicianMD00043129WA

General Provider Information

NPI Number : 1013904143
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY A CONNELL M.D.
Provider Business Mailing Address
First Line : PO BOX 5157
Second Line :
City : VANCOUVER
State : WA
Zip : 98668-5157
Country : US
Telephone Number : 360-667-3056
Fax Number : 360-666-0466
Provider Business Practice Location Address
First Line : 400 NE MOTHER JOSEPH PL
Second Line :
City : VANCOUVER
State : WA
Zip : 98664-3200
Country : US
Telephone Number : 360-667-3056
Fax Number : 360-666-0466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 04/02/2009

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