Provider Demographics
NPI:1881908382
Name:CONNER, RETROYREO DEMONZA (SUB IDC)
Entity type:Individual
Prefix:MR
First Name:RETROYREO
Middle Name:DEMONZA
Last Name:CONNER
Suffix:
Gender:M
Credentials:SUB IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3000
Mailing Address - Country:US
Mailing Address - Phone:757-339-4621
Mailing Address - Fax:
Practice Address - Street 1:USS NEW MEXICO (SSN 779)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09524-2405
Practice Address - Country:US
Practice Address - Phone:757-339-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman