Provider Demographics
NPI:1568576205
Name:CONNER, GARY J (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:CONNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5100 SPRINGFIELD ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1261
Mailing Address - Country:US
Mailing Address - Phone:937-259-9900
Mailing Address - Fax:937-259-9999
Practice Address - Street 1:1 WYOMING ST
Practice Address - Street 2:SUITE 4130
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2722
Practice Address - Country:US
Practice Address - Phone:937-208-6810
Practice Address - Fax:937-222-7255
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD024974E207V00000X
MS20076207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001403635-0015Medicaid
PA19587OtherACOG
MS512G700003OtherUP MCARE PTAN
MSP00707005OtherRAILROAD PTAN
MS03479303OtherMEDICAID UP MS MC
PAC30324OtherUPIN