MEDICARE: MR. JEFFREY PATRICK CONROY CRNA

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	367500000X	Certified Registered Nurse Anesthetist	659523	TX

General Provider Information

NPI Number	:	1205826096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY PATRICK CONROY CRNA

Provider Business Mailing Address
First Line	:	PO BOX 691286
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-1286
Country	:	US
Telephone Number	:	210-370-7608
Fax Number	:

Provider Business Practice Location Address
First Line	:	5837 DE ZAVALA RD UNIT 691286
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-0790
Country	:	US
Telephone Number	:	210-370-7608
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	07/06/2021

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