Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 778 | WY |
NPI | 1346738713 |
---|---|
Provider Name | Dr. Stevey Conder |
First Address | Rock Springs, WY 82901-4769 |
Second Address | Rock Springs, WY 82901-4769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2018 |
Last Update Date | 01/05/2018 |