MEDICARE: DR. MARY IRENE OCONNOR 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	207X00000X	Orthopaedic Surgery Physician	ME59025	FL

General Provider Information

NPI Number	:	1891785713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY IRENE OCONNOR M.D.

Provider Business Mailing Address
First Line	:	3205 OCEAN DR S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5956
Country	:	US
Telephone Number	:	904-607-8348
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 OCEAN DR S
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-5956
Country	:	US
Telephone Number	:	904-607-8348
Fax Number	:

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

Provider Enumeration Date	:	10/22/2005
Last Update Date	:	01/31/2024

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