Provider Demographics
NPI:1487804589
Name:O'CONNOR, RORY STEPHEN (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:RORY
Middle Name:STEPHEN
Last Name:O'CONNOR
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Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:500 W FORT ST
Mailing Address - Street 2:# 111
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-422-1325
Mailing Address - Fax:208-422-1319
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:# 111
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-422-1325
Practice Address - Fax:208-422-1319
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2022-08-25
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Provider Licenses
StateLicense IDTaxonomies
IDPA-770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant