Provider Demographics
NPI:1982603569
Name:CONOVER, PAUL NMN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:NMN
Last Name:CONOVER
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 1:3080 ACKERMAN BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3555
Mailing Address - Country:US
Mailing Address - Phone:937-293-6188
Mailing Address - Fax:937-293-6196
Practice Address - Street 1:3080 ACKERMAN BLVD
Practice Address - Street 2:STE 205
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-3555
Practice Address - Country:US
Practice Address - Phone:937-293-6188
Practice Address - Fax:937-293-6196
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-07-27
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
OH35.065836208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0330501Medicaid
OH9287721Medicare ID - Type Unspecified
G41726Medicare UPIN