Provider Demographics
NPI:1043520992
Name:CONRAD, JOHN C (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:CONRAD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3507
Mailing Address - Country:US
Mailing Address - Phone:509-946-5233
Mailing Address - Fax:509-946-5326
Practice Address - Street 1:846 STEVENS DR
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3507
Practice Address - Country:US
Practice Address - Phone:509-946-5233
Practice Address - Fax:509-946-5326
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other