Provider Demographics
NPI:1356392310
Name:O'CONNOR, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:O'CONNOR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1002 PERUQUE CROSSING CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2362
Mailing Address - Country:US
Mailing Address - Phone:636-294-5900
Mailing Address - Fax:636-294-5908
Practice Address - Street 1:1002 PERUQUE CROSSING CT
Practice Address - Street 2:SUITE 101
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2362
Practice Address - Country:US
Practice Address - Phone:636-294-5900
Practice Address - Fax:636-294-5908
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-11-13
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Provider Licenses
StateLicense IDTaxonomies
MO35988207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
11310762OtherCAQH
MOMA1721004OtherMEDICARE PTAN