Healthcare Provider Details

I. General information

NPI: 1982603452
Provider Name (Legal Business Name): FOREST REGINALD CONLEY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 N MORLEY ST
MOBERLY MO
65270-3666
US

IV. Provider business mailing address

1600 N MORLEY ST
MOBERLY MO
65270-3666
US

V. Phone/Fax

Practice location:
  • Phone: 660-372-9595
  • Fax: 660-372-9596
Mailing address:
  • Phone: 660-372-9595
  • Fax: 660-372-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7880
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: