Provider Demographics
NPI:1861836413
Name:CARL CONNORS OBGYN LLC
Entity Type:Organization
Organization Name:CARL CONNORS OBGYN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-727-3280
Mailing Address - Street 1:4705 MONTGOMERY BLVD NE STE 105
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1246
Mailing Address - Country:US
Mailing Address - Phone:505-727-3280
Mailing Address - Fax:505-727-3282
Practice Address - Street 1:4705 MONTGOMERY BLVD NE STE 105
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1246
Practice Address - Country:US
Practice Address - Phone:505-727-3280
Practice Address - Fax:505-727-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-913-90174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty