Individual
DR. DONALD J KONRAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1224 8TH ST, RUPERT, ID 83350-1527
(208) 436-5266
(208) 434-8675
Mailing address
1224 8TH ST, RUPERT, ID 83350-1527
(208) 436-5266
(208) 434-8675
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O154
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10001772
REGENCE BLUESHIELD
ID
05
—
M0014062
—
ID
01
—
S1543
BLUE CROSS
ID
Enumeration date
10/25/2005
Last updated
01/06/2012
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