Provider Demographics
NPI:1669676227
Name:CONNER, CATHERINE SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:SUE
Last Name:CONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W HWY 6
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5591
Mailing Address - Country:US
Mailing Address - Phone:254-399-8364
Mailing Address - Fax:
Practice Address - Street 1:601 W HWY 6
Practice Address - Street 2:SUITE 102
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5591
Practice Address - Country:US
Practice Address - Phone:254-399-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9221208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
2776875325OtherMYUTMB 2776875325-COMMERCIAL NUMBER
TX8K7166Medicare PIN