Provider Demographics
NPI:1013547736
Name:CONRAD, EVAN WILLIAM (PA)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:WILLIAM
Last Name:CONRAD
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:3316 GRAND FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8138
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 HIGHWAY 352 STE 100
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6805
Practice Address - Country:US
Practice Address - Phone:972-270-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-22
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant