Provider Demographics
NPI:1871772129
Name:CONNOR, WILLARD WESLEY JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:WESLEY
Last Name:CONNOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16885 W BERNARDO DR
Mailing Address - Street 2:SUITE 235
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1618
Mailing Address - Country:US
Mailing Address - Phone:619-550-3201
Mailing Address - Fax:619-342-7527
Practice Address - Street 1:16885 W BERNARDO DR
Practice Address - Street 2:SUITE 235
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1618
Practice Address - Country:US
Practice Address - Phone:619-550-3201
Practice Address - Fax:619-342-7527
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1020332084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry