Provider Demographics
NPI:1538928627
Name:CONDRA, DAVID ALEXANDER
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALEXANDER
Last Name:CONDRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5805 NORTHSHORE CIR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4668
Mailing Address - Country:US
Mailing Address - Phone:423-355-6509
Mailing Address - Fax:
Practice Address - Street 1:5805 NORTHSHORE CIR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4668
Practice Address - Country:US
Practice Address - Phone:423-355-6509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program