Provider Demographics
NPI:1114255460
Name:CONNER, DAVID JAMES
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:CONNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-2400
Mailing Address - Country:US
Mailing Address - Phone:209-470-7139
Mailing Address - Fax:209-938-0281
Practice Address - Street 1:211 E IRIS AVE
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-2400
Practice Address - Country:US
Practice Address - Phone:209-470-7139
Practice Address - Fax:209-938-0281
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)