Provider Demographics
NPI:1598857096
Name:CONYERS, JAMES ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:CONYERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3705 MEDICAL PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1019
Mailing Address - Country:US
Mailing Address - Phone:512-302-1210
Mailing Address - Fax:512-451-9752
Practice Address - Street 1:3705 MEDICAL PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1019
Practice Address - Country:US
Practice Address - Phone:512-302-1210
Practice Address - Fax:512-451-9752
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4268208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B21964Medicare UPIN
TX8L15763Medicare PIN