Individual
CHARLES DOBBIN CONNOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5669
(618) 288-0998
(618) 288-9934
Mailing address
22 PROFESSIONAL PARK DR, MARYVILLE, IL 62062-5669
(618) 288-0998
(618) 288-9934
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
IL
207NS0135X
Procedural Dermatology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0300073
UNITEDHEATHCARE
IL
01
—
06032047
BLUE CROSS/BLUE SHIELD
IL
01
—
127279
GHP
IL
01
—
1736541
FIRST HEALTH
IL
01
—
2119084
AETNA MANAGED CARE
IL
01
—
2644579
CIGNA
IL
01
—
294801
HEALTHLINK
IL
01
—
4233211
AETNA
IL
01
—
5226143
CCN
IL
01
—
G37507
MERCY
IL
Enumeration date
05/03/2006
Last updated
12/27/2007
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