1003054800 NPI number — MR. AUSTIN PAUL CONNER SR. R.PH

Table of content: MR. AUSTIN PAUL CONNER SR. R.PH (NPI 1003054800)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003054800 NPI number — MR. AUSTIN PAUL CONNER SR. R.PH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONNER
Provider First Name:
AUSTIN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
R.PH
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CONNER
Provider Other First Name:
AUSTIN
Provider Other Middle Name:
PAUL
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPH
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003054800
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
599 MEHARG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32577-5571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-587-2680
Provider Business Mailing Address Fax Number:
850-479-0806

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 W HWY 98
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-587-2680
Provider Business Practice Location Address Fax Number:
850-479-0806
Provider Enumeration Date:
02/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  13156 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com