Provider Demographics
NPI:1760786933
Name:OCONNOR FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:OCONNOR FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-385-0600
Mailing Address - Street 1:309 E FARWELL RD
Mailing Address - Street 2:204
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-8207
Mailing Address - Country:US
Mailing Address - Phone:509-385-0600
Mailing Address - Fax:509-466-4798
Practice Address - Street 1:309 E FARWELL RD
Practice Address - Street 2:204
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-8207
Practice Address - Country:US
Practice Address - Phone:509-385-0600
Practice Address - Fax:509-466-4798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA603063268OtherUBI
WA1029367Medicaid
WADR3582OtherRR PTAN
WAG8899209OtherGROUP PTAN
WADR3582OtherRR PTAN