Provider Demographics
NPI:1972512861
Name:JOHN W CONBOY MD PA
Entity type:Organization
Organization Name:JOHN W CONBOY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CONBOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-488-4558
Mailing Address - Street 1:3141 NW 63RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116
Mailing Address - Country:US
Mailing Address - Phone:405-607-1318
Mailing Address - Fax:405-607-1326
Practice Address - Street 1:280 PATTERSON ROAD
Practice Address - Street 2:STE #4
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844
Practice Address - Country:US
Practice Address - Phone:407-894-6618
Practice Address - Fax:863-422-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0076815207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9461Medicare ID - Type Unspecified
H05841Medicare UPIN