Healthcare Provider Details

I. General information

NPI: 1841338936
Provider Name (Legal Business Name): CHRISTOPHER C. CONGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105N LAWRENCE
CUBA MO
65453
US

IV. Provider business mailing address

PO BOX 579
ROLLA MO
65402
US

V. Phone/Fax

Practice location:
  • Phone: 573-885-1077
  • Fax: 573-885-1080
Mailing address:
  • Phone: 573-458-3425
  • Fax: 573-426-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number108738
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: