MEDICARE: FORREST CRAIG CONRATH M.D.

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	174400000X	Specialist	5454	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487694956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FORREST CRAIG CONRATH M.D.

Provider Business Mailing Address
First Line	:	236 W 6TH ST
Second Line	:	SUITE 400
City	:	RENO
State	:	NV
Zip	:	89503-4517
Country	:	US
Telephone Number	:	775-329-0873
Fax Number	:	775-329-1026

Provider Business Practice Location Address
First Line	:	5423 RENO CORPORATE DR.
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89511-2250
Country	:	US
Telephone Number	:	775-329-0873
Fax Number	:	775-329-1026

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/21/2018

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