1164551594

Everything you always wanted to know about DR. KOTHEIMER CONRAD GREGORY M.D. but were afraid to ask.

DR. KOTHEIMER CONRAD GREGORY M.D.

You can also download the this 1164551594 data report as csv | excel | json | xml
Provider Prefix Provider Last Name Provider Middle Name Provider First Name Provider Credential
DR. KOTHEIMER CONRAD GREGORY M.D.
Gender:
Male
Enumeration date:
2007-03-02
Last update date:
2007-07-08
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state
B24091 Medicare UPIN none TX

Taxonomies

Taxonomy State License Number Primary?
207R00000X Internal Medicine MP 0410 Y

Phone Numbers

Type Number
Practice Location Address Fax Number 6702368600
Mailing Address Telephone Number 9035957349
Practice Location Address Telephone Number 6702852626
Mailing Address Fax Number 9035931966

Addresses

Type Address City State Postal Country
Mailing Address 3728 SOUTHPARK DR TYLER TX 75703 TX
Practice Location Address 1 LOWER NAVY HILL GARAPAN SAIPAN 0 SAIPAN

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