Basic Information
| Provider Information | |||||||||
| NPI: | 1568576205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONNER | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 SPRINGFIELD ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454311261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372599900 | ||||||||
| FaxNumber: | 9372599999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WYOMING ST | ||||||||
| Address2: | SUITE 4130 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372086810 | ||||||||
| FaxNumber: | 9372227255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 11/23/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD024974E | PA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VG0400X | 20076 | MS | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 001403635-0015 | 05 | PA | MEDICAID | 19587 | 01 | PA | ACOG | OTHER | 512G700003 | 01 | MS | UP MCARE PTAN | OTHER | P00707005 | 01 | MS | RAILROAD PTAN | OTHER | 03479303 | 01 | MS | MEDICAID UP MS MC | OTHER | C30324 | 01 | PA | UPIN | OTHER |