Provider Demographics
NPI:1063401768
Name:O'CONNOR, MARY A (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:HINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2012 ROCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MCGREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-3450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2012 ROCKBRIDGE RD
Practice Address - Street 2:
Practice Address - City:MCGREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-3450
Practice Address - Country:US
Practice Address - Phone:360-757-6489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038085207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8251274Medicaid
WA8251274Medicaid
WAAB14020Medicare ID - Type Unspecified