Provider Demographics
NPI:1427387711
Name:CONNER, AMY LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LOUISE
Last Name:CONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1515 N HARVARD AVE
Mailing Address - Street 2:STE E
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-4957
Mailing Address - Country:US
Mailing Address - Phone:918-832-6049
Mailing Address - Fax:
Practice Address - Street 1:3100 MEDICAL PKWY
Practice Address - Street 2:STE 100
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-1088
Practice Address - Country:US
Practice Address - Phone:918-341-1000
Practice Address - Fax:918-293-3141
Is Sole Proprietor?:No
Enumeration Date:2009-12-15
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK19074207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine