Provider Demographics
NPI:1689757502
Name:CONNERS, JERRY W (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:W
Last Name:CONNERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:40 NORTH GRAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FT. THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075
Mailing Address - Country:US
Mailing Address - Phone:859-781-2700
Mailing Address - Fax:859-781-2712
Practice Address - Street 1:40 N GRAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-4107
Practice Address - Country:US
Practice Address - Phone:859-781-2700
Practice Address - Fax:859-781-2712
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-10-30
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Provider Licenses
StateLicense IDTaxonomies
KY15481207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64154818Medicaid
KY0711401Medicare ID - Type Unspecified
KY64154818Medicaid
KY7114Medicare PIN