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NPI Code Detail

MEDICARE: DR. KARYN JESTER CONDIE M.D. , MPH,, PHD

MEDICARE: DR. KARYN JESTER CONDIE M.D. , MPH,, PHD
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
1207Q00000XFamily Medicine Physician0101228770VA
2207QA0505XAdult Medicine Physician25914OK
3207QA0505XAdult Medicine PhysicianN1986TX
42083A0100XAerospace Medicine PhysicianN1986TX

General Provider Information

NPI Number : 1871582429
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KARYN JESTER CONDIE M.D. , MPH,, PHD
Provider Business Mailing Address
First Line : 1515 TRUEMBER STREET
Second Line : REID CLINIC - LACKLAND AIR FORCE BASE
City : SAN ANTONIO
State : TX
Zip : 78236
Country : US
Telephone Number : 210-671-5015
Fax Number :
Provider Business Practice Location Address
First Line : 1515 TRUEMPER ST
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78236-5583
Country : US
Telephone Number : 210-671-5015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 03/07/2014

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