Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1184812125 |
---|---|
Provider Name | Mark A Conry |
First Address | Long Beach, CA 90813-3244 |
Second Address | Long Beach, CA 90813-3244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2007 |
Last Update Date | 03/10/2007 |