Basic Information
| Provider Information | |||||||||
| NPI: | 1265589774 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | O'CONNOR | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | WALTER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 748249 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303748249 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523366000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4500 NEWBERRY RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326072245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523366000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 06/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 40469 | AZ | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 0101241018 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 047438 | CT | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | ME151430 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | CN1748 | 01 | AZ | RAILROAD MEDICARE | OTHER |