Individual
JASON ALBERT CONRAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0312
(817) 317-7033
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0312
(817) 317-7033
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
M1598
TX
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
M1598
TX
2085N0700X
Neuroradiology Physician
M1598
TX
2085R0202X
Diagnostic Radiology Physician
Primary
M1598
TX
2085U0001X
Diagnostic Ultrasound Physician
M1598
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M1598
TX LICENSE
TX
Enumeration date
06/12/2007
Last updated
08/14/2012
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