Provider Demographics
NPI:1881646677
Name:CONROY, PITR GERARD (MD)
Entity Type:Individual
Prefix:
First Name:PITR
Middle Name:GERARD
Last Name:CONROY
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 1:2074 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4948
Mailing Address - Country:US
Mailing Address - Phone:707-696-2307
Mailing Address - Fax:
Practice Address - Street 1:98 HENDLEY ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5025
Practice Address - Country:US
Practice Address - Phone:707-527-0412
Practice Address - Fax:797-527-6048
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G496040Medicare ID - Type Unspecified
A51414Medicare UPIN