Provider Demographics
NPI:1598976714
Name:OCONNOR PHYSICIAN GROUP INC
Entity Type:Organization
Organization Name:OCONNOR PHYSICIAN GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-753-1986
Mailing Address - Street 1:1660 SAN PABLO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2077
Mailing Address - Country:US
Mailing Address - Phone:510-724-7488
Mailing Address - Fax:
Practice Address - Street 1:1690 SAN PABLO AVE
Practice Address - Street 2:SUITE F
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2078
Practice Address - Country:US
Practice Address - Phone:925-753-1986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-28
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44531207Q00000X
CAA446530207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty