Provider Demographics
NPI:1679584684
Name:O'CONNOR, KATHY JEAN (MD)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:JEAN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26028
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6028
Mailing Address - Country:US
Mailing Address - Phone:505-262-3212
Mailing Address - Fax:505-232-1532
Practice Address - Street 1:5150 JOURNAL CENTER BLVD NE FL 2
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5900
Practice Address - Country:US
Practice Address - Phone:505-262-3212
Practice Address - Fax:505-232-1532
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27775207R00000X
NMMD2014-0587207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ480088Medicaid
NM90558235Medicaid
NM804682OtherCMS