OrganizationBryan R Conklin Md PcFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address2011 Fourth Street, La Grande, OR 97850-1200(541) 963-4139PECOS EnrollmentBased on the most recent information from CMS, provider Bryan R Conklin Md Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1659558591Provider TypeOrganizationFull NameBryan R Conklin Md PcSubpartNoEnumeration Date1/23/2008Last Updated4/19/2012Contact InformationPractice LocationPractice Address2011 Fourth Street, La Grande, OR 97850-1200Phone(541) 963-4139Fax(541) 963-4412Mailing LocationMailing Address2011 Fourth Street, La Grande, OR 97850-1200Phone(541) 963-4139Fax(541) 963-4412Authorized OfficialNameConklin, Bryan R (President)Phone(541) 963-4139Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseMD23049OregonProvider IdentifiersIDDescriptionIssuerID228792DescriptionMedicaidIssuerUnlistedOregon