MEDICARE: ANTHONY J O'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
1	174400000X	Specialist	K5169	TX

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	:	1255423182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY J O'CONNELL M.D.

Provider Business Mailing Address
First Line	:	12222 N CENTRAL EXPY
Second Line	:	SUITE 240
City	:	DALLAS
State	:	TX
Zip	:	75243-3755
Country	:	US
Telephone Number	:	972-235-8088
Fax Number	:	972-235-8090

Provider Business Practice Location Address
First Line	:	12222 N CENTRAL EXPY
Second Line	:	SUITE 240
City	:	DALLAS
State	:	TX
Zip	:	75243-3755
Country	:	US
Telephone Number	:	972-235-8088
Fax Number	:	972-235-8090

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	09/21/2011

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