Provider Demographics
NPI:1144368523
Name:ROBERSON, CONRAD E (DO)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:E
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1910 IDAHO ST
Mailing Address - Street 2:SUITE #101
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2692
Mailing Address - Country:US
Mailing Address - Phone:775-738-6256
Mailing Address - Fax:775-738-9469
Practice Address - Street 1:1910 IDAHO ST
Practice Address - Street 2:SUITE # 101
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-2692
Practice Address - Country:US
Practice Address - Phone:775-738-6256
Practice Address - Fax:775-738-9469
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV1099207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100500738Medicaid