Provider Demographics
NPI:1801870035
Name:THOMAS, KONRAD BOYD (MD)
Entity type:Individual
Prefix:DR
First Name:KONRAD
Middle Name:BOYD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2185 W GRANT LINE RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7309
Mailing Address - Country:US
Mailing Address - Phone:209-839-3300
Mailing Address - Fax:209-839-6310
Practice Address - Street 1:2185 W GRANT LINE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7309
Practice Address - Country:US
Practice Address - Phone:209-839-3300
Practice Address - Fax:209-839-6310
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053008L207V00000X
IN01052897A207V00000X
OH75587207V00000X
CAG87954207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G04226Medicare UPIN