Provider Demographics
NPI:1982603452
Name:CONLEY, FOREST REGINALD (DO)
Entity type:Individual
Prefix:
First Name:FOREST
Middle Name:REGINALD
Last Name:CONLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N MORLEY ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-3666
Mailing Address - Country:US
Mailing Address - Phone:660-372-9595
Mailing Address - Fax:660-372-9596
Practice Address - Street 1:1600 N MORLEY ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-3666
Practice Address - Country:US
Practice Address - Phone:660-372-9595
Practice Address - Fax:660-372-9596
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD41692Medicare UPIN