Provider Demographics
NPI:1871530469
Name:CONNER, KEVIN EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EUGENE
Last Name:CONNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 731218
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-1219
Mailing Address - Country:US
Mailing Address - Phone:903-315-1488
Mailing Address - Fax:903-315-1656
Practice Address - Street 1:700 E MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5580
Practice Address - Country:US
Practice Address - Phone:903-315-1488
Practice Address - Fax:903-315-1656
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH77152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE51685Medicare UPIN