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General NPI Number Information
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NPI Number | 1528267333
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Entity Type | Organization
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Legal Business Name | RACHEL S CONRAD MD PC
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 100A LAROSA
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City | LONG BEACH
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State | MS
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Zip | 39560
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Country | US
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Telephone | 228-868-6530
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Fax |
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Provider Business Mailing Address
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Address Line | 100 A LAROSA
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City | LONG BEACH
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State | MS
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Zip | 39560
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Country | US
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Telephone | 228-868-6530
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Fax |
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Authorized Official
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Title or Position | OWER/PHYSICIAN
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Name | DR. RACHEL SUSAN CONRAD
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Credential | M.D.
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Telephone | 228-868-6530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 18000
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License Number State | MS
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