Provider Demographics
NPI:1689630584
Name:CONRAD, DANIEL SCOTLAND (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:SCOTLAND
Last Name:CONRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9801 DUPONT AVE S
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3100
Mailing Address - Country:US
Mailing Address - Phone:952-888-5800
Mailing Address - Fax:952-884-2656
Practice Address - Street 1:9801 DUPONT AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-3100
Practice Address - Country:US
Practice Address - Phone:952-888-5800
Practice Address - Fax:952-884-2656
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2020-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN41851207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN501721100Medicaid
MN501721100Medicaid
MN180001100Medicare ID - Type Unspecified