Provider Demographics
NPI:1598054009
Name:ANTHONY J O'CONNELL, M.D., P.A.
Entity Type:Organization
Organization Name:ANTHONY J O'CONNELL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-235-8088
Mailing Address - Street 1:PO BOX 451388
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-1388
Mailing Address - Country:US
Mailing Address - Phone:972-235-8088
Mailing Address - Fax:972-235-8090
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:SUITE 240
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3720
Practice Address - Country:US
Practice Address - Phone:972-235-8088
Practice Address - Fax:972-235-8090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030929601Medicaid
TX00696DMedicare PIN
TX030929601Medicaid