Individual
DR. CONRAD FRANKLIN DIVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13677 W MCDOWELL RD, SUITE 201, GOODYEAR, AZ 85395
(623) 536-4200
(623) 882-4201
Mailing address
9250 N 3RD ST STE 3015, PHOENIX, AZ 85020-2425
(602) 633-3721
(602) 595-1127
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
46967
AZ
2086S0102X
Surgical Critical Care Physician
46967
AZ
2086S0127X
Trauma Surgery Physician
46967
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
901433
—
AZ
Enumeration date
07/14/2007
Last updated
08/22/2018
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