Provider Demographics
NPI:1730154477
Name:CONWAY, PHILIP G (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:G
Last Name:CONWAY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:755 DUNN RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-1751
Mailing Address - Country:US
Mailing Address - Phone:314-731-1113
Mailing Address - Fax:314-731-4020
Practice Address - Street 1:755 DUNN RD
Practice Address - Street 2:SUITE 110
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1751
Practice Address - Country:US
Practice Address - Phone:314-731-1113
Practice Address - Fax:314-731-4020
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2015-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR2B08207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110161920OtherRAILROAD MEDICARE
MO967255280Medicare PIN
MOA11415Medicare UPIN