Provider Demographics
NPI:1275503351
Name:O'CONNOR, MARTIN FRANCIS (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:FRANCIS
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 GOLDEN PEDAL ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6936
Mailing Address - Country:US
Mailing Address - Phone:702-804-0611
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL ATTN PROFESSIONAL AFFAIRS
Practice Address - Street 2:MAGTFTC MCAGCC BOX 788250
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92278-8250
Practice Address - Country:US
Practice Address - Phone:760-830-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511988367500000X
COCRNA000348367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVEV819YMedicare PIN