Healthcare Provider Details

I. General information

NPI: 1730177700
Provider Name (Legal Business Name): DANIEL J CONRAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 191 AND HOSPITAL ROAD
CHINLE AZ
86503
US

IV. Provider business mailing address

PO BOX PH
CHINLE AZ
86503-8000
US

V. Phone/Fax

Practice location:
  • Phone: 928-674-7050
  • Fax: 928-674-7600
Mailing address:
  • Phone: 928-674-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number15244
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01027750A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number56064
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: