Provider Demographics
NPI:1972604627
Name:CONRAD, ALAN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JOHN
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 1:15721 POMERADO ROAD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2021
Mailing Address - Country:US
Mailing Address - Phone:858-485-6644
Mailing Address - Fax:858-618-5976
Practice Address - Street 1:15721 POMERADO ROAD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2021
Practice Address - Country:US
Practice Address - Phone:858-485-6644
Practice Address - Fax:858-618-5976
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48437207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92819Medicare UPIN
WG48437Medicare ID - Type Unspecified