Provider Demographics
NPI:1437333168
Name:CONKLIN, CODY LARAINE (MD)
Entity Type:Individual
Prefix:MRS
First Name:CODY
Middle Name:LARAINE
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CODY
Other - Middle Name:LARAINE
Other - Last Name:CONKLIN-AGUILERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1090 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-3700
Mailing Address - Country:US
Mailing Address - Phone:928-442-5495
Mailing Address - Fax:866-812-1253
Practice Address - Street 1:51 S BRIAN MICKELSEN PKWY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3610
Practice Address - Country:US
Practice Address - Phone:928-639-8132
Practice Address - Fax:866-279-8919
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40958208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics