Individual
DR. JEFFREY MARK CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6144 AIRPORT BLVD, MOBILE, AL 36608-3143
(251) 476-5050
(251) 450-2770
Mailing address
PO BOX 86144, MOBILE, AL 36689-6144
(251) 476-5050
(251) 450-2770
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
00025851
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009960785
—
AL
01
—
051522492
BCBS
AL
05
—
05723278
—
MS
01
—
631187140
TAX ID
—
01
—
P00143020
RAILROAD MEDICARE
—
Enumeration date
05/02/2006
Last updated
01/20/2010
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