Healthcare Provider Details

I. General information

NPI: 1104899566
Provider Name (Legal Business Name): CONRAD J CLEMENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E AJO WAY
TUCSON AZ
85713-6204
US

IV. Provider business mailing address

2701 E ELVIRA RD
TUCSON AZ
85756-7124
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-4750
  • Fax: 520-874-4751
Mailing address:
  • Phone: 520-874-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29838
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: