Provider Demographics
NPI:1639219553
Name:CONDIE, JOHN DOUGLAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:CONDIE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:12305 OBRAD DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-3519
Mailing Address - Country:US
Mailing Address - Phone:408-257-2948
Mailing Address - Fax:408-257-5231
Practice Address - Street 1:2505 SAMARITAN DRIVE
Practice Address - Street 2:SUITE 601
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4017
Practice Address - Country:US
Practice Address - Phone:408-358-1024
Practice Address - Fax:408-358-1075
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2011-07-25
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Provider Licenses
StateLicense IDTaxonomies
CAG451672086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery