Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 142 | SD |
NPI | 1033113832 |
---|---|
Provider Name | Dr. Dan P Conrad |
First Address | Rapid City, SD 57702-0321 |
Second Address | Rapid City, SD 57702-0321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 15/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6801050 | (05) | SD |
U55799 | (02) | SD |