Individual
THEODORE C ONDRACEK
Active
Individual
THEODORE C ONDRACEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
MD25555
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022893
—
OR
01
—
38D0627400
CLIA
OR
01
—
P00188466
RAILROAD
OK
Enumeration date
01/27/2006
Last updated
09/12/2008
Update your record
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