Individual
DR. ETHAN TANNER O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1233 34TH ST NW, BEMIDJI, MN 56601-5112
(218) 333-5596
Mailing address
1233 34TH ST NW, BEMIDJI, MN 56601-5112
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
106348
MN
207Q00000X
Family Medicine Physician
TL1362
WY
208600000X
Surgery Physician
4301092736
MI
Other
Enumeration date
10/01/2008
Last updated
09/27/2012
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