Provider Demographics
NPI:1467957951
Name:OHMART, CONNOR H (MD)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:H
Last Name:OHMART
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 1:5422 E FARMDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2954
Mailing Address - Country:US
Mailing Address - Phone:480-734-5864
Mailing Address - Fax:
Practice Address - Street 1:5422 E FARMDALE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2954
Practice Address - Country:US
Practice Address - Phone:480-734-5864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63242207P00000X
CAA165691207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty