Provider Demographics
NPI:1750375028
Name:CONNER, WILLIAM JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JORDAN
Last Name:CONNER
Suffix:
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 1:211 W MATTHEWS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1309
Mailing Address - Country:US
Mailing Address - Phone:704-708-4301
Mailing Address - Fax:704-708-4389
Practice Address - Street 1:211 W MATTHEWS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1309
Practice Address - Country:US
Practice Address - Phone:704-708-4301
Practice Address - Fax:704-708-4389
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891239RMedicaid
NC2344531Medicare ID - Type UnspecifiedGROUP ID NUMBER
NC891239RMedicaid
NC2279871EMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER ID