Individual
TIMMIE JOE CONRAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
204 BRECKENRIDGE LANE, LOUISVILLE, KY 40207
(502) 899-7778
(502) 897-5757
Mailing address
PO BOX 6015, LOUISVILLE, KY 40206-0015
(502) 899-7778
(502) 897-5757
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
01041184
IN
207W00000X
Ophthalmology Physician
Primary
29088
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64290885
—
KY
Enumeration date
12/05/2006
Last updated
12/18/2014
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