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General NPI Number Information
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NPI Number | 1841428059
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Entity Type | Individual
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Provider Name | BRANDON NELSON CONRAD M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2009
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Last Update Date | 06/26/2023
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Provider Practice Location Address
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Address Line | 168 E REYNOLDS RD STE 110
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City | LEXINGTON
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State | KY
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Zip | 40517-1242
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Country | US
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Telephone | 859-494-9072
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Fax | 859-269-0948
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Provider Business Mailing Address
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Address Line | 1152 IRON LACE CT
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City | LEXINGTON
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State | KY
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Zip | 40509-2343
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Country | US
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Telephone | 859-494-9072
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Fax | 859-269-0948
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 47034
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License Number State | KY
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