Provider Demographics
NPI:1972802999
Name:CONDIE, ALAN SKIDMORE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:SKIDMORE
Last Name:CONDIE
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 1:1375 KRISTIE LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-2229
Mailing Address - Country:US
Mailing Address - Phone:801-583-8501
Mailing Address - Fax:
Practice Address - Street 1:1375 KRISTIE LN
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-2229
Practice Address - Country:US
Practice Address - Phone:801-583-8501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT167821-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine