| Bryan R Conklin Md Pc | |
|
2011 Fourth Street La Grande OR 97850-1200 | |
| (541) 963-4139 | |
| (541) 963-4412 |
| Full Name | Bryan R Conklin Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 2011 Fourth Street, La Grande, Oregon |
| Authorized Official Name and Position | Bryan R Conklin (PRESIDENT) |
| Authorized Official Contact | 5419634139 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bryan R Conklin Md Pc 2011 Fourth Street La Grande OR 97850-1200 Ph: (541) 963-4139 | Bryan R Conklin Md Pc 2011 Fourth Street La Grande OR 97850-1200 Ph: (541) 963-4139 |
| NPI Number | 1659558591 |
|---|---|
| Provider Enumeration Date | 01/23/2008 |
| Last Update Date | 04/19/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659558591 | NPI | - | NPPES |
| 228792 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD23049 (Oregon) | Primary |
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