Individual
LOUISE M CONVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02833
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110193281
RR MEDICARE
—
05
—
3122713
—
IA
01
—
I99090050
MEDICARE PTAN
IA
Enumeration date
05/18/2006
Last updated
07/01/2014
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