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Individual

JOHN T CONNOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PNP

Contact information

Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-1475
(682) 885-7520
Mailing address
PO BOX 99371, FORT WORTH, TX 76199-0371
(682) 885-1855
(682) 885-7347

Taxonomy

Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
640797
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
282160501
TX
01
282160502
CSHCN
TX
Enumeration date
06/18/2007
Last updated
04/03/2012
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