Provider Demographics
NPI:1487013165
Name:CONNER, DOUGLAS KEITH (OPA-C)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:KEITH
Last Name:CONNER
Suffix:
Gender:M
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2818 MEADOWSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-3418
Mailing Address - Country:US
Mailing Address - Phone:214-418-0317
Mailing Address - Fax:
Practice Address - Street 1:2818 MEADOWSIDE DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-3418
Practice Address - Country:US
Practice Address - Phone:214-418-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2017-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical