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 today at 11:52 AM.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