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1982684197

NPI Code Detail

MEDICARE: DR. CLINT G CONNOR MD

MEDICARE: DR. CLINT G CONNOR 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	036108965	IL
2	208M00000X	Hospitalist Physician	036108965	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	721089	OTHER	IL	AETNA
2	3932056	OTHER	IL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	084974	OTHER		HEALTH ALLIANCE
5	555252	OTHER		HEALTHLINK

General Provider Information

NPI Number	:	1982684197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLINT G CONNOR MD

Provider Business Mailing Address
First Line	:	17 DEER RUN
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-2468
Country	:	US
Telephone Number	:	618-889-0590
Fax Number	:

Provider Business Practice Location Address
First Line	:	2401 W MAIN ST
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-1188
Country	:	US
Telephone Number	:	618-997-5311
Fax Number	:

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	05/13/2022

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Directions to “ DR. CLINT G CONNOR MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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