Basic Information
| Provider Information | |||||||||
| NPI: | 1114116019 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERALD F. CONNER MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 E CHEVES ST | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436796881 | ||||||||
| FaxNumber: | 8436796883 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E CHEVES ST | ||||||||
| Address2: | SUITE 280 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436796881 | ||||||||
| FaxNumber: | 8436796883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2007 | ||||||||
| LastUpdateDate: | 10/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | LEGGETT | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
| AuthorizedOfficialMiddleName: | REGINA | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8436796881 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0122X | 27687 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 276873 | 05 | SC | MEDICAID |