Provider Demographics
NPI:1154882454
Name:O'CONNOR, JOSEPH WALTER (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WALTER
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SW 10TH AVE
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1301
Mailing Address - Country:US
Mailing Address - Phone:785-354-6241
Mailing Address - Fax:785-270-4343
Practice Address - Street 1:929 SW MULVANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1677
Practice Address - Country:US
Practice Address - Phone:785-270-4100
Practice Address - Fax:785-270-4202
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS02234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program