Provider Demographics
NPI:1366487928
Name:O'CONNOR, BRIAN L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:L
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 E BLUEBIRD PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-5633
Mailing Address - Country:US
Mailing Address - Phone:480-556-1884
Mailing Address - Fax:
Practice Address - Street 1:3232 E BLUEBIRD PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5633
Practice Address - Country:US
Practice Address - Phone:480-556-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611435Medicaid
SD5611437Medicaid
SD5611430Medicaid
SD4994151OtherWELLMARK
SD5215OtherDAKOTACARE
SD5611436Medicaid
SD4994152OtherWELLMARK
SD5611436Medicaid
SDS101089Medicare PIN