Provider Demographics
NPI:1396709721
Name:O'CONNOR, JOHN KEVIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KEVIN
Last Name:O'CONNOR
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:7777 FOREST LN STE D110
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2567
Practice Address - Country:US
Practice Address - Phone:972-566-7031
Practice Address - Fax:972-566-2690
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 2000422085R0001X
TXM54152085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8P8219OtherBCBS
TX8BR088OtherBCBS
TX187711004Medicaid
TX187711003Medicaid
LAH94764Medicare UPIN
TX387208YM09Medicare PIN
TX187711003Medicaid
TX8J3819Medicare PIN
TXP00674666Medicare PIN
TXP01449593Medicare PIN
TX387208YKYCMedicare PIN