Provider Demographics
NPI:1477594992
Name:O'CONNOR, JUDITH ANN (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N PHILLIPS AVE STE 14400
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4600
Mailing Address - Country:US
Mailing Address - Phone:405-271-5312
Mailing Address - Fax:405-271-1151
Practice Address - Street 1:1200 N PHILLIPS AVE STE 14400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-5312
Practice Address - Fax:405-271-1151
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00045522208000000X
ARE54092080P0206X
OK281142080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1659580001Medicaid
WA8437717Medicaid
AR5AC10Medicare UPIN
WA8855337Medicare PIN
AR1659580001Medicaid