Provider Demographics
NPI:1063513737
Name:GARBUTT, GLENN DONALD (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:DONALD
Last Name:GARBUTT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1381 E HERNDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3307
Mailing Address - Country:US
Mailing Address - Phone:559-448-8481
Mailing Address - Fax:559-448-0996
Practice Address - Street 1:1191 E HERNDON AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3164
Practice Address - Country:US
Practice Address - Phone:559-448-8481
Practice Address - Fax:559-448-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG13844207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG13844OtherCALIFORNIA LICENSE
CA00G138440Medicaid
CA130019522Medicare PIN
CAA39103Medicare UPIN
CA00G138440Medicare PIN
CA00G138442Medicare PIN