Provider Demographics
NPI:1710098272
Name:CONNOR, ANN REYNOLDS (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:REYNOLDS
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E HIGHLAND AVE STE 251
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3800
Practice Address - Country:US
Practice Address - Phone:909-882-4605
Practice Address - Fax:909-475-2680
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068600A208G00000X
KY46719208G00000X
CAG67226208G00000X
PAMD440110208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G67226Medicaid
CARHC134387OtherX-RAY SUPERVISOR LIC
CA00G67226Medicaid
CARHC134387OtherX-RAY SUPERVISOR LIC