Provider Demographics
NPI:1750386165
Name:CONGER, DEAN M (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:M
Last Name:CONGER
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 1:426 SW 153RD ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2215
Mailing Address - Country:US
Mailing Address - Phone:206-243-9378
Mailing Address - Fax:206-248-1425
Practice Address - Street 1:426 SW 153RD ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2215
Practice Address - Country:US
Practice Address - Phone:206-243-9378
Practice Address - Fax:206-248-1425
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD34429207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1102086Medicaid
WA5294750001Medicare NSC
WAF46558Medicare UPIN
WAG8805739Medicare ID - Type UnspecifiedMEDICARE GROUP
WA1102086Medicaid