Provider Demographics
NPI:1487648986
Name:CONANT, RAYMOND W (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:W
Last Name:CONANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:2115 N KANSAS AVE #201
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-0249
Mailing Address - Country:US
Mailing Address - Phone:402-462-5109
Mailing Address - Fax:402-462-6368
Practice Address - Street 1:2115 N KANSAS AVE
Practice Address - Street 2:#201
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-2644
Practice Address - Country:US
Practice Address - Phone:402-462-5109
Practice Address - Fax:402-462-6368
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE12839208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E29129Medicare UPIN
093527Medicare ID - Type Unspecified