Provider Demographics
NPI:1841211018
Name:JAMES F CONNOR PA
Entity Type:Organization
Organization Name:JAMES F CONNOR PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDRENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:CONCEPCION
Authorized Official - Last Name:CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:904-824-8088
Mailing Address - Street 1:1851 OLD MOULTRIE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-4168
Mailing Address - Country:US
Mailing Address - Phone:904-824-8088
Mailing Address - Fax:904-826-4105
Practice Address - Street 1:1851 OLD MOULTRIE RD
Practice Address - Street 2:SUITE A
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-4168
Practice Address - Country:US
Practice Address - Phone:904-824-8088
Practice Address - Fax:904-826-4105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263119900Medicaid
4283452OtherAETNA
7080262005OtherCIGNA
100699OtherAVMED
=========OtherUNITED HEALTH CARE
100699OtherAVMED
=========OtherUNITED HEALTH CARE
K3031Medicare PIN