Provider Demographics
NPI:1871548099
Name:CONLEY, AMY R (MD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:R
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12479 TELECOM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0913
Mailing Address - Country:US
Mailing Address - Phone:813-972-4199
Mailing Address - Fax:813-972-5753
Practice Address - Street 1:3100 E FLETCHER AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4613
Practice Address - Country:US
Practice Address - Phone:813-971-6000
Practice Address - Fax:813-615-7590
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-08-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME79991207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261548700Medicaid
FL01659OtherBC/BS OF FLORIDA
FL01659XMedicare PIN
FL01659ZMedicare PIN
H43935Medicare UPIN
FLP00280673Medicare PIN
FL01659YMedicare PIN