Provider Demographics
NPI:1104926898
Name:CONNOLLY, HUGH JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:HUGH
Middle Name:JOSEPH
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8135 SW 158TH TER
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2244
Mailing Address - Country:US
Mailing Address - Phone:305-251-3434
Mailing Address - Fax:305-238-1046
Practice Address - Street 1:15053 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7930
Practice Address - Country:US
Practice Address - Phone:305-251-3434
Practice Address - Fax:305-971-6688
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0014984207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL91364AMedicare ID - Type Unspecified
FLD59608Medicare UPIN