Provider Demographics
NPI:1639127632
Name:O'CONNOR, WILLIAM THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:O'CONNOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:THOMAS
Other - Last Name:O'CONNOR
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 MASON ST.
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4506
Mailing Address - Country:US
Mailing Address - Phone:707-446-0422
Mailing Address - Fax:707-446-1655
Practice Address - Street 1:300 MASON ST.
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4506
Practice Address - Country:US
Practice Address - Phone:707-446-0422
Practice Address - Fax:707-446-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG048496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G484960Medicaid
CA00G484960Medicaid
CA00G484960Medicare PIN