Provider Demographics
NPI:1801896246
Name:MCCONNELL, TAMMY S (DO)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:S
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:SUE
Other - Last Name:HOOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1912 W. 35TH ST.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703
Mailing Address - Country:US
Mailing Address - Phone:512-451-5161
Mailing Address - Fax:512-451-1258
Practice Address - Street 1:1912 W. 35TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703
Practice Address - Country:US
Practice Address - Phone:512-451-5161
Practice Address - Fax:512-451-1258
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9249208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8S5306OtherBCBS PIN
TX8S5306OtherBCBS PIN