Provider Demographics
NPI:1053759035
Name:O'CONNOR, DEVLIN (DO)
Entity type:Individual
Prefix:
First Name:DEVLIN
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5250
Mailing Address - Country:US
Mailing Address - Phone:352-343-0181
Mailing Address - Fax:352-343-0812
Practice Address - Street 1:3330 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5250
Practice Address - Country:US
Practice Address - Phone:352-343-0181
Practice Address - Fax:352-343-0812
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315059352207Q00000X
FLOS15123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine