Provider Demographics
NPI:1619230513
Name:CONNER, BRANDY M (DO)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:M
Last Name:CONNER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:BRANDY
Other - Middle Name:M
Other - Last Name:LUFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-648-7760
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-2640
Practice Address - Country:US
Practice Address - Phone:214-648-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20190332052085R0202X
KS94079592085R0202X
TXR83362085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology