Provider Demographics
NPI:1750385357
Name:CONNER, TIMOTHY A (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:CONNER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17310 WRIGHT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2405
Mailing Address - Country:US
Mailing Address - Phone:833-228-6889
Mailing Address - Fax:877-853-0376
Practice Address - Street 1:17310 WRIGHT ST STE 103
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2405
Practice Address - Country:US
Practice Address - Phone:833-228-6889
Practice Address - Fax:877-853-0376
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180359392085R0202X
GUMC-1982085R0202X
FLME1398262085R0202X
WV158912085R0202X
WY11756C2085R0202X
GUMTL-2023-0282085R0202X
ND154952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV14175Medicaid
WV14193OtherCARELINK & CARELINK PEIA
KY64942105Medicaid
WV000034924OtherFREEDOM BLUE & MS BCBS
WV0119966000Medicaid
WV151237200OtherUS DOL & US POSTAL COMP
WV020011800OtherFEDERAL BLACK LUNG
OH2047190Medicaid
WV0130753OtherUMWA
WV55-0516458OtherGROUP FEIN #
WV550516458OtherACORDIA NATIONAL PEIA
WV550516458Medicaid
WVF23457OtherBRICKSTREET INSURANCE
WV550516458Medicaid
WV14193OtherCARELINK & CARELINK PEIA
WVF23457OtherBRICKSTREET INSURANCE
WV020011800OtherFEDERAL BLACK LUNG