Provider Demographics
NPI:1285130724
Name:WILES, CONNOR L (MD)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:L
Last Name:WILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CONNOR
Other - Middle Name:L
Other - Last Name:WILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:150 PIONEER LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2556
Mailing Address - Country:US
Mailing Address - Phone:760-873-5811
Mailing Address - Fax:
Practice Address - Street 1:152 PIONEER LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2563
Practice Address - Country:US
Practice Address - Phone:760-872-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.0006980390200000X
CAA174969208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program