Provider Demographics
NPI:1932453917
Name:CONLEY, BRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9191 PINECROFT DR.
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2807
Mailing Address - Country:US
Mailing Address - Phone:281-909-7722
Mailing Address - Fax:281-909-7733
Practice Address - Street 1:9191 PINECROFT DR.
Practice Address - Street 2:SUITE 225
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-2807
Practice Address - Country:US
Practice Address - Phone:281-909-7722
Practice Address - Fax:281-909-7733
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH59.000433213ES0103X
TX2151213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery