Provider Demographics
NPI:1578647889
Name:CONYERS, DAN W (CPO)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:W
Last Name:CONYERS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10195 SW EGRET PL
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8417
Mailing Address - Country:US
Mailing Address - Phone:503-869-7202
Mailing Address - Fax:503-524-5297
Practice Address - Street 1:123 W TORRANCE BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3610
Practice Address - Country:US
Practice Address - Phone:503-869-7202
Practice Address - Fax:503-524-5297
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORCPO 1254246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other