Provider Demographics
NPI:1659465458
Name:O'CONNOR, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13365 OVERSEAS HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050
Mailing Address - Country:US
Mailing Address - Phone:305-743-9436
Mailing Address - Fax:305-743-9612
Practice Address - Street 1:13365 OVERSEAS HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050
Practice Address - Country:US
Practice Address - Phone:305-743-9436
Practice Address - Fax:305-743-9612
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377984000Medicaid
FL25759OtherBLUE CROSS OF FL
FLK2999Medicare ID - Type Unspecified
FL25759OtherBLUE CROSS OF FL