Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 33473 | AZ |
Y | 207N00000X | Dermatologist | 35091436 | OH |
NPI | 1003891052 |
---|---|
Provider Name | Michael P Conroy |
First Address | Dayton, OH 45429-2347 |
Second Address | Dublin, OH 43016-9624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000581571 | ANTHEM BLUE CROSS/BLUE SHIELD (01) | OH |
86080015085259B051 | TRIWEST (01) | AZ |
I24005 | (02) | |
P00200386 | RAILROAD MEDICARE (01) | AZ |
P00713302 | RAILROAD MEDICARE (01) | OH |