Healthcare Provider Details

I. General information

NPI: 1487694956
Provider Name (Legal Business Name): FORREST CRAIG CONRATH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5423 RENO CORPORATE DR.
RENO NV
89511-2250
US

IV. Provider business mailing address

236 W 6TH ST SUITE 400
RENO NV
89503-4517
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-0873
  • Fax: 775-329-1026
Mailing address:
  • Phone: 775-329-0873
  • Fax: 775-329-1026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5454
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: