Provider Demographics
NPI:1043556574
Name:CONNOR, KEITH MAURICE II
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:MAURICE
Last Name:CONNOR
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL UNDERSEA MEDICAL INSTITUTE
Mailing Address - Street 2:BOX 159 SUBASE NLON
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NAVAL UNDERSEA MEDICAL INSTITUTE
Practice Address - Street 2:BOX 159 SUBASE NLON
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5159
Practice Address - Country:US
Practice Address - Phone:443-572-9610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman