Basic Information
| Provider Information | |||||||||
| NPI: | 1023194883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONRAD | ||||||||
| FirstName: | ERNEST | ||||||||
| MiddleName: | U | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6400 FANNIN ST STE 1700 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770301526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069401747 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5420 WEST LOOP S STE 2400 | ||||||||
| Address2: | |||||||||
| City: | BELLAIRE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774012118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134863550 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD00024030 | WA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 2086X0206X | R7693 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 207X00000X | R7693 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 7330 | 01 | INTERNAL ID-MOTOR VEHICLE ID | OTHER | 8105223 | 05 | WA | MEDICAID |