Provider Demographics
NPI:1376542555
Name:CONKLIN, THOMAS R (MD PC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:294 EAST MOANA LANE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-4634
Mailing Address - Country:US
Mailing Address - Phone:775-329-2020
Mailing Address - Fax:775-827-0843
Practice Address - Street 1:294 E MOANA LN
Practice Address - Street 2:SUITE 22
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4641
Practice Address - Country:US
Practice Address - Phone:775-329-2020
Practice Address - Fax:775-827-0843
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV3484207W00000X
CAC033718207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFS4901304Medicaid
NV0020.16648Medicaid
NV38118Medicare PIN
CAFS4901304Medicaid
NVA35356Medicare UPIN