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Bryan Richard Conklin

Family Medicine

Allopathic & Osteopathic Physicians

2011 Fourth Street, La Grande, OR 97850-1200

PECOS Enrollment

This provider is enrolled in PECOS as BRYAN CONKLIN.

Based on the most recent information from CMS, provider Bryan Richard Conklin is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 4 days ago.

Profile Details

Provider ID
1346334075
Provider Type
Individual
Full Name
Conklin, Bryan Richard
Title
Dr.
Credential
MD PC

Gender
Male
Sole Proprietor
No
Enumeration Date
10/3/2006
Last Updated
4/19/2012

Contact Information

Practice Location

2011 Fourth Street, La Grande, OR 97850-1200

(541) 963-4139

(541) 963-4412

Mailing Location

2011 Fourth Street, La Grande, OR 97850

(541) 963-4139

(541) 963-4412

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License MD23049 Oregon

Provider Identifiers

ID	Description	Issuer
ID 228792	Description Medicaid	Issuer Unlisted Oregon

Bryan Richard Conklin

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

John Schaefer Md Pc

Tolle, Michelle

Schaefer, John E

Davis, Brooke

Kim R. Montee, M.D., P.C.

Tracy, Tracey Kathleen

Grande Ronde Hospital Inc

Tishman, Naghmeh

Tolle, Bryan

Thomas, Larissa Ann