Basic Information
| Provider Information | |||||||||
| NPI: | 1053759035 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'CONNOR | ||||||||
| FirstName: | DEVLIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3330 WATERMAN WAY | ||||||||
| Address2: | |||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327785250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523430181 | ||||||||
| FaxNumber: | 3523430812 | ||||||||
| Practice Location | |||||||||
| Address1: | 3330 WATERMAN WAY | ||||||||
| Address2: | |||||||||
| City: | TAVARES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327785250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523430181 | ||||||||
| FaxNumber: | 3523430812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2013 | ||||||||
| LastUpdateDate: | 03/29/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5315059352 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | OS15123 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.