Provider Demographics
NPI:1851384945
Name:OCONNOR, LUAN (DO)
Entity Type:Individual
Prefix:
First Name:LUAN
Middle Name:
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3813 WEYMOUTH WOODS DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7940
Mailing Address - Country:US
Mailing Address - Phone:330-441-2692
Mailing Address - Fax:330-975-6156
Practice Address - Street 1:3813 WEYMOUTH WOODS DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7940
Practice Address - Country:US
Practice Address - Phone:330-441-2692
Practice Address - Fax:330-975-6156
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004754O207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0757373Medicaid
OHOC0675802Medicare ID - Type Unspecified
OH0757373Medicaid