Individual
DR. MARILYN J CONNORS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
609 N CAROL MALONE BLVD, GRAYSON, KY 41143-1123
(606) 474-7892
(606) 474-0040
Mailing address
PO BOX 1595, ASHLAND, KY 41105-1595
(606) 408-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
03296
KY
207Q00000X
Family Medicine Physician
1103
SC
207Q00000X
Family Medicine Physician
231855
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011036
—
SC
05
—
02550365
—
NY
05
—
3085101
—
OH
05
—
3810018418
—
WV
05
—
7100129340
—
KY
01
—
P00873783
RR MEDICARE
KY
Enumeration date
05/11/2006
Last updated
04/12/2011
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