Provider Demographics
NPI:1922787258
Name:MCINTYRE, CONNOR JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:JAMES
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 E ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-5033
Mailing Address - Country:US
Mailing Address - Phone:435-671-9036
Mailing Address - Fax:
Practice Address - Street 1:1101 N CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1844
Practice Address - Country:US
Practice Address - Phone:602-344-6550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ9794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant