Provider Demographics
NPI:1023019734
Name:O'CONNOR, LAURENCE T (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:T
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L
Other - Middle Name:THOMAS
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1025 MARSH ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4752
Mailing Address - Country:US
Mailing Address - Phone:507-625-4031
Mailing Address - Fax:
Practice Address - Street 1:1025 MARSH ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4752
Practice Address - Country:US
Practice Address - Phone:507-625-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC82800208800000X
MN53823208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC828000Medicaid
TN3821447Medicare ID - Type Unspecified
TN3821446Medicaid
TN3714759Medicare PIN
TN1260440002Medicare NSC
TN1669416442OtherGROUP NPI
TN020247799OtherEEOICP
TN3106050OtherBLUE CROSS
TNCI2260OtherRAILROAD MEDICARE
TNG73933Medicare UPIN
TN3714750Medicare PIN