Organization
SAMUEL A MCCONKEY III MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL A MCCONKEY III MD, PC (OFFICE MANAGER)
(602) 375-2020
Entity
Organization
Contact information
Practice address
5830 W THUNDERBIRD RD, SUITE B5, GLENDALE, AZ 85306-4654
(602) 375-2020
(602) 978-0116
Mailing address
315 ILLINOIS STREET, SUITE 103B, FAIRBANKS, AK 99701-2910
(907) 456-7767
(907) 456-8050
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
27424
AZ
207W00000X
Ophthalmology Physician
849
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD0849
—
AK
01
—
P00401344
MEDICARE RR
AK
01
—
PP0401344
MEDICARE RAILROAD
—
Enumeration date
09/18/2007
Last updated
04/15/2011
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