Provider Demographics
NPI:1568427177
Name:O'CONNELL, DEBORAH M (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:M
Last Name:O'CONNELL
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 1:4109 LAKEPLACE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1623
Mailing Address - Country:US
Mailing Address - Phone:512-422-9153
Mailing Address - Fax:512-328-5676
Practice Address - Street 1:4109 LAKEPLACE LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-1623
Practice Address - Country:US
Practice Address - Phone:512-422-9153
Practice Address - Fax:512-328-5676
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG87372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128508103Medicaid
TXE12293Medicare UPIN
TX128508103Medicaid
TX300025170Medicare PIN