Provider Demographics
NPI:1912981754
Name:CONLEY, GILBERT REID (DPM)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:REID
Last Name:CONLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:G
Other - Middle Name:REID
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:5311 LIMESTONE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1222
Mailing Address - Country:US
Mailing Address - Phone:302-234-3907
Mailing Address - Fax:302-234-3927
Practice Address - Street 1:5311 LIMESTONE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1246
Practice Address - Country:US
Practice Address - Phone:302-234-3907
Practice Address - Fax:302-234-3927
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE10000089213E00000X
DEE1-0000089213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE4370221OtherAETNA
DE117167OtherAETNA HMO
DE0000196317Medicaid
DE249943OtherMAMSI
DE117167OtherAETNA HMO
DEC0581139Medicare PIN
DE4370221OtherAETNA