Provider Demographics
NPI:1093779902
Name:CONRAD, PAUL DEWITT (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:DEWITT
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 1:7505 81ST PL SE
Mailing Address - Street 2:PAUL D. CONRAD, MD
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5936
Mailing Address - Country:US
Mailing Address - Phone:206-236-3070
Mailing Address - Fax:206-236-3070
Practice Address - Street 1:7505 81ST PL SE
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-5936
Practice Address - Country:US
Practice Address - Phone:206-236-3070
Practice Address - Fax:206-236-3070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA25903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist