Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 2004-0285 | NM |
N | 207X00000X | Orthopaedic Surgeon | MD2010-0085 | NM |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD2010-0085 | NM |
NPI | 1033258058 |
---|---|
Provider Name | Clayton B Conrad |
First Address | Albuquerque, NM 87106 |
Second Address | Albuquerque, NM 87106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 05/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
81880553 | (05) | NM |