Provider Demographics
NPI:1811128077
Name:CONLEY, THOMAS R (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:CONLEY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1031 PIERCE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-4669
Mailing Address - Country:US
Mailing Address - Phone:419-557-5541
Mailing Address - Fax:419-557-5542
Practice Address - Street 1:2520 COLUMBUS AVE STE F
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5547
Practice Address - Country:US
Practice Address - Phone:567-867-2520
Practice Address - Fax:419-626-5640
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2023-10-10
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Provider Licenses
StateLicense IDTaxonomies
OH58.003093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0067290Medicaid
OHH101460OtherMEDICARE
OHP01094691OtherMEDICARE RR