Provider Demographics
NPI:1861092777
Name:CONNER, ANTHONY DARRYL
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DARRYL
Last Name:CONNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W HAYDEN PARK RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-6079
Mailing Address - Country:US
Mailing Address - Phone:623-565-2716
Mailing Address - Fax:
Practice Address - Street 1:127 W HAYDEN PARK RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-6079
Practice Address - Country:US
Practice Address - Phone:623-565-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171W00000XOther Service ProvidersContractor
No347E00000XTransportation ServicesTransportation Broker