Provider Demographics
NPI:1881897908
Name:CONWAY, DEIRDRE (MD)
Entity type:Individual
Prefix:DR
First Name:DEIRDRE
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1446 W PLEASANT GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3216
Mailing Address - Country:US
Mailing Address - Phone:801-785-5100
Mailing Address - Fax:
Practice Address - Street 1:1446 W PLEASANT GROVE BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3216
Practice Address - Country:US
Practice Address - Phone:801-785-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-12884207VE0102X
CAA99248207V00000X
UT8343768-1205207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty