Provider Demographics
NPI:1851479059
Name:O CONNELL, JOHN FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANCIS
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 1:131 GARNER GROVE COVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9763
Mailing Address - Country:US
Mailing Address - Phone:901-854-4416
Mailing Address - Fax:
Practice Address - Street 1:131 GARNER GROVE COVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-9763
Practice Address - Country:US
Practice Address - Phone:901-491-9447
Practice Address - Fax:901-854-3530
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD10289207R00000X
MS16265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3183346Medicaid
TN3183346Medicaid
3183346Medicare ID - Type Unspecified