Provider Demographics
NPI:1538102934
Name:CONNOR, CHARLES KEITH (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:KEITH
Last Name:CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3705 W 15TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7753
Practice Address - Country:US
Practice Address - Phone:972-867-3577
Practice Address - Fax:972-985-9433
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9577207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1413OtherBLUE CROSS OF TEXAS
TX43100901Medicaid
TX43100902Medicaid
G57243Medicare UPIN
TX43100902Medicaid
TX43100901Medicaid
TX8259M4Medicare PIN