MEDICARE: DR. JOHN J O'CONNELL III DO

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	OS8509	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	:	1720028186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J O'CONNELL III DO

Provider Business Mailing Address
First Line	:	PO BOX 735911
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-5911
Country	:	US
Telephone Number	:	972-675-7266
Fax Number	:	972-607-4655

Provider Business Practice Location Address
First Line	:	2614 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4311
Country	:	US
Telephone Number	:	850-215-3000
Fax Number	:	850-215-3150

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/02/2024

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