MEDICARE: MR. JEFFREY TODD CONNOR

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	171WV0202X	Vehicle Modifications Contractor	8500004462	FL

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	:	1114943958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY TODD CONNOR

Provider Business Mailing Address
First Line	:	20354 US HIGHWAY 27
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-8794
Country	:	US
Telephone Number	:	352-429-3972
Fax Number	:	352-429-8811

Provider Business Practice Location Address
First Line	:	20354 US HIGHWAY 27
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34715-8794
Country	:	US
Telephone Number	:	352-429-3972
Fax Number	:	352-429-8811

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	06/25/2009

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