MEDICARE: SUSAN CONROY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	L1549	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8X9561	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1518182518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN CONROY DO

Provider Business Mailing Address
First Line	:	100 ALEDO GROVE CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-6049
Country	:	US
Telephone Number	:	817-320-9956
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 ALEDO GROVE CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76126-6049
Country	:	US
Telephone Number	:	817-320-9956
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	05/07/2015

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Directions to “ SUSAN CONROY DO” Practice Location

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