Provider Demographics
NPI:1306826201
Name:CONLEY, DEAN RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:RAYMOND
Last Name:CONLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9349 PARK WEST BLVD
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4335
Mailing Address - Country:US
Mailing Address - Phone:865-531-8294
Mailing Address - Fax:
Practice Address - Street 1:9349 PARK WEST BLVD
Practice Address - Street 2:SUITE # 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4306
Practice Address - Country:US
Practice Address - Phone:865-531-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD008976207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702710Medicaid
TNB59269Medicare UPIN
TN3702710Medicaid