Provider Demographics
NPI:1043444037
Name:O,CONNOR, CORNELIUS JUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:JUDE
Last Name:O,CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 S HARBOR DR APT 402
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32967-7009
Mailing Address - Country:US
Mailing Address - Phone:772-562-0867
Mailing Address - Fax:
Practice Address - Street 1:4860 S HARBOR DR APT 402
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967-7009
Practice Address - Country:US
Practice Address - Phone:772-562-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 67386207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine