Provider Demographics
NPI:1740575810
Name:MCCONNELL, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:MCCONNELL
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 1:7220 WEST RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72135-9595
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7220 WEST RIDGE RD.
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:AR
Practice Address - Zip Code:72135-9595
Practice Address - Country:US
Practice Address - Phone:501-868-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-4398207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology