Grady, Connie L
Grady, Connie L is an individual health care provider with primary practice located at 2371 Ne Stephens St Suite 200, Roseburg OR 97470-1372. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Grady, Connie L can be contacted via phone (541) 672-8533.Contact Information
Primary practice address
2371 Ne Stephens St Suite 200
Roseburg OR 97470-1372
Phone: (541) 672-8533
Fax: (541) 672-4993
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | MD21306 | Oregon |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | MD21306 | Oregon |
Profile Details
| NPI number | 1740266816 |
|---|---|
| LBN Legal business name | Grady, Connie L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 20th, 2005 |
| Last updated | Aug 15th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1740266816 | NPPES |
| Oregon | MEDICAID | 165772 |
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