Provider Demographics
NPI:1033207261
Name:CONRAD, LARRY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:PAUL
Last Name:CONRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BINZ
Mailing Address - Street 2:#1230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004
Mailing Address - Country:US
Mailing Address - Phone:713-524-9209
Mailing Address - Fax:713-524-2086
Practice Address - Street 1:1200 BINZ
Practice Address - Street 2:#1230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004
Practice Address - Country:US
Practice Address - Phone:713-524-9209
Practice Address - Fax:713-524-2086
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5037207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B21959Medicare UPIN
00N062Medicare ID - Type Unspecified