Organization
THERESA M. CONYAC MD PLLC
Active
Other names
GLOW
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA M CONYAC MD (OWNER, MD)
(972) 722-2526
Entity
Organization
Contact information
Practice address
6705 HERITAGE PARKWAY, SUITE 102, ROCKWALL, TX 75087-8749
(972) 722-2526
(972) 722-2528
Mailing address
6705 HERITAGE PARKWAY, SUITE 102, ROCKWALL, TX 75087-8749
(972) 722-2526
(972) 722-2528
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
P8875
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1598965188
—
IL
Enumeration date
01/11/2018
Last updated
08/26/2019
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