Provider Demographics
NPI:1538472212
Name:GERALD J OCONNOR MD PA
Entity Type:Organization
Organization Name:GERALD J OCONNOR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-659-1238
Mailing Address - Street 1:1411 N FLAGLER DR
Mailing Address - Street 2:SUITE 6200
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3404
Mailing Address - Country:US
Mailing Address - Phone:561-659-1238
Mailing Address - Fax:561-659-0492
Practice Address - Street 1:1411 N FLAGLER DR
Practice Address - Street 2:SUITE 6200
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3404
Practice Address - Country:US
Practice Address - Phone:561-659-1238
Practice Address - Fax:561-659-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31871174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL50844AMedicare PIN
FLC19987Medicare UPIN