Provider Demographics
NPI:1831140193
Name:O'CONNOR, JOHN THOMAS JR (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:O'CONNOR
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WANDA ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OK
Mailing Address - Zip Code:73448-1229
Mailing Address - Country:US
Mailing Address - Phone:580-276-2400
Mailing Address - Fax:580-276-4358
Practice Address - Street 1:301 WANDA ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OK
Practice Address - Zip Code:73448-1229
Practice Address - Country:US
Practice Address - Phone:580-276-2400
Practice Address - Fax:580-276-4358
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKE09718Medicare UPIN