Provider Demographics
NPI:1447234216
Name:CONYERS, CARY LEE (MD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:LEE
Last Name:CONYERS
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 1:504 W PUEBLO ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-6211
Mailing Address - Country:US
Mailing Address - Phone:805-962-1822
Mailing Address - Fax:805-962-1822
Practice Address - Street 1:504 W PUEBLO ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6211
Practice Address - Country:US
Practice Address - Phone:805-962-1822
Practice Address - Fax:805-962-1822
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2374208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG237410Medicaid
CAG237410Medicaid
G23741Medicare ID - Type Unspecified