Provider Demographics
NPI:1790767986
Name:CONNOR, BERNARD JOSEPH (PAC)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:JOSEPH
Last Name:CONNOR
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701
Mailing Address - Country:US
Mailing Address - Phone:406-782-9132
Mailing Address - Fax:406-723-9270
Practice Address - Street 1:1101 S MONTANA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701
Practice Address - Country:US
Practice Address - Phone:406-782-9132
Practice Address - Fax:406-723-9270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT86363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT439093Medicaid
MT00008360Medicare ID - Type Unspecified