Provider Demographics
NPI:1891785713
Name:OCONNOR, MARY IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:IRENE
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 OCEAN DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-5956
Mailing Address - Country:US
Mailing Address - Phone:904-607-8348
Mailing Address - Fax:
Practice Address - Street 1:3205 OCEAN DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-5956
Practice Address - Country:US
Practice Address - Phone:904-607-8348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59025207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200014303OtherRAILROAD MEDICARE
FL11957OtherBLUECROSS/BLUESHIELD
FL054704201Medicaid
FL11957OtherBLUECROSS/BLUESHIELD
FL054704201Medicaid