Individual
DEBORAH K CONNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3635 VISTA AVE, WEST PAVILION, RM 315, SAINT LOUIS, MO 63110-2539
(314) 577-8776
(314) 268-5697
Mailing address
3691 RUTGER ST, PROVIDER ENROLLMENT, SAINT LOUIS, MO 63110-2515
(314) 977-6828
(314) 977-6777
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
R7P78
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207241704
—
MO
01
—
P00275082
RR MEDICARE
MO
01
—
P00648705
RR MEDICARE
MO
Enumeration date
10/06/2006
Last updated
04/02/2009
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