Lisa B Connery Md Pllc | |
1125 N Porter Ave Suite 205 Norman OK 73071-6446 | |
(405) 701-4079 | |
(405) 701-2838 |
Full Name | Lisa B Connery Md Pllc |
---|---|
Speciality | Family Medicine |
Location | 1125 N Porter Ave, Norman, Oklahoma |
Authorized Official Name and Position | Dava Bradley (OFFICE MANAGER) |
Authorized Official Contact | 4057014079 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Lisa B Connery Md Pllc 1125 N Porter Ave Suite 205 Norman OK 73071-6446 Ph: (405) 701-4079 | Lisa B Connery Md Pllc 1125 N Porter Ave Suite 205 Norman OK 73071-6446 Ph: (405) 701-4079 |
NPI Number | 1275604811 |
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Provider Enumeration Date | 11/13/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 2961504196 |
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Medicare Enrollment ID | O20081117000701 |
Identifier | Type | State | Issuer |
---|---|---|---|
1275604811 | NPI | - | NPPES |
4206638 | Other | OK | AETNA |
444742697002 | Other | OK | BCBS |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | MD16929 (Oklahoma) | Primary |
Provider Name | Lisa B Connery |
---|---|
Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1205828977 PECOS PAC ID: 6709887086 Enrollment ID: I20070130000189 |
Provider Name | Mishell J Kerr |
---|---|
Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1023460318 PECOS PAC ID: 5597051292 Enrollment ID: I20160907000193 |
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