| 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 |
|---|---|
| Provider Enumeration Date | 11/13/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 2961504196 |
|---|---|
| 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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