Provider Demographics
NPI:1336486224
Name:CONNORS, JOHN ALLAN (IDC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ALLAN
Last Name:CONNORS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL SUBMARINE BASE NEW LONDON, BOX 900
Mailing Address - Street 2:NAVAL SUBMARINE MEDICAL RESEARCH LABORATORY
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5900
Mailing Address - Country:US
Mailing Address - Phone:860-694-2558
Mailing Address - Fax:860-694-4809
Practice Address - Street 1:1 WAHOO DRIVE
Practice Address - Street 2:NAVAL BRANCH HEALTH CLINIC
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349
Practice Address - Country:US
Practice Address - Phone:860-694-4123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman