Provider Demographics
NPI:1750495982
Name:MCCONNELL, DAVID D (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:MCCONNELL
Suffix:
Gender:M
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:PO BOX 201
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-0201
Mailing Address - Country:US
Mailing Address - Phone:308-236-5506
Mailing Address - Fax:308-236-7089
Practice Address - Street 1:115 E 52ND ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-0502
Practice Address - Country:US
Practice Address - Phone:308-236-5506
Practice Address - Fax:308-236-7089
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19312207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE34653OtherBCBS OF NE
NE10025789300Medicaid
NENA1425001Medicare PIN