Healthcare Provider Details

I. General information

NPI: 1750386165
Provider Name (Legal Business Name): DEAN M CONGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 SW 153RD ST
BURIEN WA
98166-2215
US

IV. Provider business mailing address

426 SW 153RD ST
BURIEN WA
98166-2215
US

V. Phone/Fax

Practice location:
  • Phone: 206-243-9378
  • Fax: 206-248-1425
Mailing address:
  • Phone: 206-243-9378
  • Fax: 206-248-1425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD34429
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: