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General NPI Number Information
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NPI Number | 1336111343
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Entity Type | Individual
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Provider Name | JON W. CONRAD D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 808 WILLOW ST
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City | COFFEYVILLE
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State | KS
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Zip | 67337-5851
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Country | US
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Telephone | 620-251-3920
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Fax | 620-251-3923
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Provider Business Mailing Address
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Address Line | 808 WILLOW ST PO BOX 374
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City | COFFEYVILLE
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State | KS
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Zip | 67337-5851
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Country | US
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Telephone | 620-251-3920
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Fax | 620-251-3923
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5417
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License Number State | KS
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