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Individual

MARK R CONNELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1613 N MCKENZIE ST, FOLEY, AL 36535-2247
(251) 476-5443
(251) 476-0116
Mailing address
PO BOX 7866, MOBILE, AL 36670-0866
(251) 476-5443
(251) 476-0116

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
24737
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009936421
AL
05
009936422
AL
05
009936423
AL
05
009936424
AL
05
009936426
AL
01
51003530
BC GREYSTONE
AL
01
51003532
BC MONTCLAIR
AL
01
51003538
BC SHELBY
AL
01
51003539
BC 280
AL
01
51003540
BC SYLACAUGA
AL
Enumeration date
04/28/2006
Last updated
12/15/2010
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