MEDICARE: DR. GEORGE CONNER III 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	207Q00000X	Family Medicine Physician	R3762	AR

Other Identifiers

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

General Provider Information

NPI Number	:	1063460335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE CONNER III MD

Provider Business Mailing Address
First Line	:	902 HOLIDAY DR
Second Line	:	STE 101
City	:	FORREST CITY
State	:	AR
Zip	:	72335-9183
Country	:	US
Telephone Number	:	870-630-1583
Fax Number	:	870-630-1362

Provider Business Practice Location Address
First Line	:	902 HOLIDAY DR
Second Line	:	STE 101
City	:	FORREST CITY
State	:	AR
Zip	:	72335-9183
Country	:	US
Telephone Number	:	870-630-1583
Fax Number	:	870-630-1362

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	01/13/2011

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