Provider Demographics
NPI:1396707253
Name:CONNER, GERALD FOSTER (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:FOSTER
Last Name:CONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7162
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:800 E CHEVES ST
Practice Address - Street 2:SUITE 280
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2650
Practice Address - Country:US
Practice Address - Phone:843-679-6881
Practice Address - Fax:843-679-6883
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC276872086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC276873Medicaid
SCAA10428552OtherMEDICARE PTAN
SC276873Medicaid
8316Medicare PIN