MEDICARE: MARY A O'CONNOR MD

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
1	207R00000X	Internal Medicine Physician	MD00038085	WA

General Provider Information

NPI Number	:	1063401768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY A O'CONNOR MD

Provider Business Mailing Address
First Line	:	2012 ROCKBRIDGE RD
Second Line	:
City	:	MCGREGOR
State	:	TX
Zip	:	76657-3450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 ROCKBRIDGE RD
Second Line	:
City	:	MCGREGOR
State	:	TX
Zip	:	76657-3450
Country	:	US
Telephone Number	:	360-757-6489
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	06/03/2024

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