Provider Demographics
NPI:1528049558
Name:CONNOR, ODEANE H (MD)
Entity type:Individual
Prefix:
First Name:ODEANE
Middle Name:H
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-4107
Mailing Address - Country:US
Mailing Address - Phone:256-546-9558
Mailing Address - Fax:256-546-9975
Practice Address - Street 1:402 S 6TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-4107
Practice Address - Country:US
Practice Address - Phone:256-546-9558
Practice Address - Fax:256-546-9975
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL237432081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051521199Medicare ID - Type Unspecified
ALG27153Medicare UPIN