Provider Demographics
NPI:1205828977
Name:CONNERY, LISA B (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:CONNERY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1010 24TH AVE NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6494
Mailing Address - Country:US
Mailing Address - Phone:405-701-4079
Mailing Address - Fax:405-701-2838
Practice Address - Street 1:1010 24TH AVE NW
Practice Address - Street 2:SUITE 110
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6494
Practice Address - Country:US
Practice Address - Phone:405-701-4079
Practice Address - Fax:405-701-2838
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-07-01
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Provider Licenses
StateLicense IDTaxonomies
OK16929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK080058651OtherRAILROAD MEDICARE
OK100113800AMedicaid
OK4206638OtherAETNA EDI
OK4206638OtherAETNA EDI