Provider Demographics
NPI:1821038092
Name:O'CONNELL, JAMES V (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:V
Last Name:O'CONNELL
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 1:2285 CORPORATE CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:
Practice Address - Street 1:72785 FRANK SINATRA DR STE 101
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3207
Practice Address - Country:US
Practice Address - Phone:760-969-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18672207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG18672OtherMEDICAL BOARD OF CA
CAG18672OtherMEDICAL BOARD OF CA
CAG18672Medicare ID - Type Unspecified
CAG18672OtherMEDICAL BOARD OF CA