Provider Demographics
NPI:1295821197
Name:CONNOR, PATRICK J (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:CONNOR
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:211 SUDDERTH
Practice Address - Street 2:LINCOLN COUNTY MEDICAL CENTER
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345
Practice Address - Country:US
Practice Address - Phone:505-257-8200
Practice Address - Fax:505-630-4233
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2006-0463207P00000X
IL036.075569207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM45972737Medicaid
N/AMedicare PIN