Provider Demographics
NPI:1982684197
Name:CONNOR, CLINT G (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:G
Last Name:CONNOR
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 1:17 DEER RUN
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-2468
Mailing Address - Country:US
Mailing Address - Phone:618-889-0590
Mailing Address - Fax:
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1188
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108965207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL721089OtherAETNA
IL3932056OtherBCBS
IL036108965Medicaid
084974OtherHEALTH ALLIANCE
555252OtherHEALTHLINK
084974OtherHEALTH ALLIANCE
H86204Medicare UPIN
IL214881075Medicare PIN
IL214881Medicare Oscar/Certification