Individual
DR. JOHN J O'CONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1002 PERUQUE CROSSING CT, SUITE 101, O FALLON, MO 63366-2362
(636) 294-5900
(636) 294-5908
Mailing address
1002 PERUQUE CROSSING CT, SUITE 101, O FALLON, MO 63366-2362
(636) 294-5900
(636) 294-5908
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35988
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11310762
CAQH
—
01
—
MA1721004
MEDICARE PTAN
MO
Enumeration date
05/15/2006
Last updated
11/13/2014
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