Provider Demographics
NPI:1477596278
Name:CONNOR, CAROLINE LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:LEE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4806
Mailing Address - Country:US
Mailing Address - Phone:707-443-8335
Mailing Address - Fax:707-443-7327
Practice Address - Street 1:2675 HARRIS ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4806
Practice Address - Country:US
Practice Address - Phone:707-443-8335
Practice Address - Fax:707-443-7327
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG02524Medicare UPIN