Provider Demographics
NPI:1669467346
Name:MCCONNELL, STUART BONAU (MD)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:BONAU
Last Name:MCCONNELL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2021 BIRCHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5905
Mailing Address - Country:US
Mailing Address - Phone:308-532-0430
Mailing Address - Fax:
Practice Address - Street 1:102 N DEWEY ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5438
Practice Address - Country:US
Practice Address - Phone:308-532-0430
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE158402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C97170Medicare UPIN