Organization
EDGAR M CONRAD IV, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDGAR M CONRAD IV DO (PROPRIETOR)
(414) 782-3292
Entity
Organization
Contact information
Practice address
2700 CUNNINGHAM AVE, SUITE 103, JOPLIN, MO 64801-1570
(417) 782-3292
(417) 782-4024
Mailing address
2700 CUNNINGHAM AVE, SUITE 103, JOPLIN, MO 64801-1570
(417) 782-3292
(417) 782-4024
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
107748
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
248016636
—
MO
Enumeration date
06/13/2008
Last updated
08/11/2008
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