Provider Demographics
NPI:1336197334
Name:CONNOR, PAUL T (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:CONNOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-734-2700
Mailing Address - Fax:360-734-8362
Practice Address - Street 1:2979 SQUALICUM PKWY
Practice Address - Street 2:SUITE #101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1811
Practice Address - Country:US
Practice Address - Phone:360-734-2700
Practice Address - Fax:360-734-8362
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60080391207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1179COOtherREGENCE BLUE SHIELD
WA7062177OtherAETNA
WAG8883525OtherMEDICARE PIN FOR SJMC
AKMD0335WMedicaid
WA82107OtherL&I AND CRIME VICTIMS FOR SJMC
WA1336197334Medicaid
WA1179COOtherREGENCE BLUE SHIELD
WAG8881916Medicare PIN