Individual provider Active NPI

Mark Conrad, D.O.

  • Family Medicine Physician
  • Garland, TX
National Provider Identifier
1265810691
Registry record updated Sep 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO2502 Issued in NV
Practice address
601 Clara Barton Blvd
Suite 340
Garland, TX 75042-5738
Phone
(469) 800-2260
NPI assigned
May 18, 2015
Last updated
Sep 16, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X R8878 TX
Family Medicine Physician 207Q00000X E-11892 AR
Family Medicine Physician 207Q00000X 15482 ND
Family Medicine Physician 207Q00000X 6550 OK
Family Medicine Physician 207Q00000X 2019000361 MO
Family Medicine Physician 207Q00000X 312293 LA
Family Medicine Physician 207Q00000X DO.2059 AL
Family Medicine Physician 207Q00000X MED-PHYS-LIC-78315 MT
Family Medicine Physician 207Q00000X 11418132-1204 UT
Family Medicine Physician 207Q00000X H88113 MD
Family Medicine Physician 207Q00000X DO2975 ME
Family Medicine Physician 207Q00000X 008193 AZ
Family Medicine Physician 207Q00000X DO2502 NV Primary

Addresses

Primary practice location

601 Clara Barton Blvd
Suite 340
Garland, TX 75042-5738

Mailing address

601 Clara Barton Blvd
Suite 340
Garland, TX 75042-5738
Phone (469) 800-2260

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO.2059ALMDFamily Medicine Physician
E-11892ARMDFamily Medicine Physician
008193AZMDFamily Medicine Physician
312293LAMDFamily Medicine Physician
H88113MDMDFamily Medicine Physician
DO2975MEMDFamily Medicine Physician
2019000361MOMDFamily Medicine Physician
MED-PHYS-LIC-78315MTMDFamily Medicine Physician
15482NDMDFamily Medicine Physician
DO2502NVMDFamily Medicine Physician
R8878TXMDFamily Medicine Physician
11418132-1204UTMDFamily Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1265810691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 CLARA BARTON BLVD",
            "address_2": "SUITE 340",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750425738",
            "telephone_number": "469-800-2260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 CLARA BARTON BLVD",
            "address_2": "SUITE 340",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750425738",
            "telephone_number": "469-800-2260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONRAD",
        "first_name": "MARK",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-18",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "R8878",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AR",
            "license": "E-11892",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ND",
            "license": "15482",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "6550",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2019000361",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "312293",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO.2059",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-78315",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "11418132-1204",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "H88113",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "DO2975",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "008193",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "DO2502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.