Provider Demographics
NPI:1306014311
Name:DAVID E. CONDON D.P.M.
Entity Type:Organization
Organization Name:DAVID E. CONDON D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-587-7790
Mailing Address - Street 1:PO BOX 10069
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96162-0069
Mailing Address - Country:US
Mailing Address - Phone:530-587-7790
Mailing Address - Fax:530-587-4293
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:#310
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-587-7790
Practice Address - Fax:530-587-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3384332B00000X
NV9403332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT11666Medicare UPIN
CA4510950001Medicare NSC
CA000E33841Medicare PIN
NVV36599Medicare PIN