Organization
JEREMY D. MCCONNELL, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY DAVID MCCONNELL MD (PRESIDENT)
(813) 404-0159
Entity
Organization
Contact information
Practice address
5717 21ST AVE W, BRADENTON, FL 34209
(941) 792-8383
(941) 792-8484
Mailing address
5717 21ST AVE W, BRADENTON, FL 34209
(941) 792-8383
(941) 792-8484
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME83356
FL
207QB0002X
Obesity Medicine (Family Medicine) Physician
ME83356
FL
207QS1201X
Sleep Medicine (Family Medicine) Physician
Primary
ME83356
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NZ725
FL HF MEDICARE
FL
Enumeration date
04/20/2016
Last updated
11/19/2021
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