Provider Demographics
NPI:1831161546
Name:CONARD, SCOTT E (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
Last Name:CONARD
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 1:12810 HILLCREST RD STE B209
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1525
Mailing Address - Country:US
Mailing Address - Phone:972-292-7158
Mailing Address - Fax:877-292-2247
Practice Address - Street 1:12810 HILLCREST RD STE B209
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-292-7158
Practice Address - Fax:877-292-2247
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183188501Medicaid
TX183188502Medicaid
TX183188503Medicaid
TXB143193OtherMEDICARE PTAN
TX8DB624OtherBCBSTX
TX8L4022Medicare PIN
TX8L4010Medicare PIN
TXB143193OtherMEDICARE PTAN
TX183188501Medicaid
TX8F5601Medicare PIN
TX8F5435Medicare PIN