Provider Demographics
NPI:1316913510
Name:CONRADY, RICKIE (MD)
Entity type:Individual
Prefix:DR
First Name:RICKIE
Middle Name:
Last Name:CONRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 659506
Mailing Address - Street 2:SECTION 4142
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-9506
Mailing Address - Country:US
Mailing Address - Phone:405-330-7000
Mailing Address - Fax:405-330-7075
Practice Address - Street 1:225 LILAC DR STE 200
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-7287
Practice Address - Country:US
Practice Address - Phone:405-330-7000
Practice Address - Fax:405-280-5661
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK14650207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10015790AMedicaid
OKE10823Medicare UPIN