Provider Demographics
NPI:1689685786
Name:OCONNELL, TIMOTHY ROGERS (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:ROGERS
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 SOUTH NEW BALLAS ROAD
Mailing Address - Street 2:SUITE 6003B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-991-2151
Mailing Address - Fax:314-991-2742
Practice Address - Street 1:621 SOUTH NEW BALLAS ROAD
Practice Address - Street 2:SUITE 6003B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-991-2151
Practice Address - Fax:314-991-2742
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO34187208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
3066028001OtherCIGNA
6960V41192OtherCARE MANAGEMENT RESOURCE
240007863OtherRAILROAD MEDICARE
000004321OtherHUMANA GOLD CHOICE
A11093OtherMERCY HEALTH PLANS
6960V41192OtherGROUP HEALTH PLANS
3066028001OtherCIGNA
6960V41192OtherCARE MANAGEMENT RESOURCE