Basic Information
| Provider Information | |||||||||
| NPI: | 1841338936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONGER | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 579 | ||||||||
| Address2: | |||||||||
| City: | ROLLA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734583425 | ||||||||
| FaxNumber: | 5734262282 | ||||||||
| Practice Location | |||||||||
| Address1: | 105N LAWRENCE | ||||||||
| Address2: | |||||||||
| City: | CUBA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738851077 | ||||||||
| FaxNumber: | 5738851080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 01/28/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 108738 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 244880811 | 05 | MO | MEDICAID |