Provider Demographics
NPI:1588474597
Name:JOSEPH, CONNER MAXWELL (STUDENT)
Entity type:Individual
Prefix:
First Name:CONNER
Middle Name:MAXWELL
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:STUDENT
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Mailing Address - Street 1:34 OAK LN
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1971
Mailing Address - Country:US
Mailing Address - Phone:304-617-6870
Mailing Address - Fax:
Practice Address - Street 1:1540 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704-9501
Practice Address - Country:US
Practice Address - Phone:304-696-6035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant