Provider Demographics
NPI:1114941812
Name:CONNER, RALPH E III (DO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:E
Last Name:CONNER
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4419
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4419
Mailing Address - Country:US
Mailing Address - Phone:818-340-9988
Mailing Address - Fax:818-587-2493
Practice Address - Street 1:3350 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3710
Practice Address - Country:US
Practice Address - Phone:714-220-4533
Practice Address - Fax:818-587-2493
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6547207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A65470OtherBLUE SHIELD
CA00AX65470Medicaid
CA00AX65470Medicaid
CA020A65470OtherBLUE SHIELD