MEDICARE: MOLLY A CONROY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD206565	OR

General Provider Information

NPI Number	:	1154827533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY A CONROY

Provider Business Mailing Address
First Line	:	MSC GENERAL SURGERY 1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 S RIVER PKWY
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-4553
Country	:	US
Telephone Number	:	503-679-5349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	01/11/2024

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Directions to “ MOLLY A CONROY ” Practice Location

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