Provider Demographics
NPI:1407061294
Name:CONERTY, JAMES ROBERT III (RSA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:CONERTY
Suffix:III
Gender:M
Credentials:RSA
Other - Prefix:
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Mailing Address - Street 1:1372 JEFFERY ST
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60915-2047
Mailing Address - Country:US
Mailing Address - Phone:815-928-8875
Mailing Address - Fax:815-933-3944
Practice Address - Street 1:750 ALMAR PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2315
Practice Address - Country:US
Practice Address - Phone:815-933-3955
Practice Address - Fax:815-933-3944
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist