Provider Demographics
NPI:1588670186
Name:CONRAD, STEPHEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:CONRAD
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 1:1850 SULLIVAN AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2223
Mailing Address - Country:US
Mailing Address - Phone:650-756-5630
Mailing Address - Fax:650-756-0136
Practice Address - Street 1:1850 SULLIVAN AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2223
Practice Address - Country:US
Practice Address - Phone:650-756-5630
Practice Address - Fax:650-756-0136
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32475207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053110Medicaid
CA00C324750Medicare PIN
CAA34949Medicare UPIN