Provider Demographics
NPI:1417928003
Name:OCONNOR, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:OCONNOR
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 1:205 S GARRISON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-2843
Mailing Address - Country:US
Mailing Address - Phone:303-237-2779
Mailing Address - Fax:303-237-4428
Practice Address - Street 1:205 S GARRISON ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-2843
Practice Address - Country:US
Practice Address - Phone:303-237-2779
Practice Address - Fax:303-237-4428
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01340777Medicaid
80226A005OtherTRICARE
080165174OtherRR MEDICARE
CO01340777Medicaid
0663600001Medicare NSC
80226A005OtherTRICARE