Provider Demographics
NPI:1124171657
Name:GLEN D. JARUS, M.D., INC.
Entity type:Organization
Organization Name:GLEN D. JARUS, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:JARUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-945-2468
Mailing Address - Street 1:6319 GREENLEAF AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-3536
Mailing Address - Country:US
Mailing Address - Phone:562-945-2468
Mailing Address - Fax:562-945-8804
Practice Address - Street 1:6319 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-3536
Practice Address - Country:US
Practice Address - Phone:562-945-2468
Practice Address - Fax:562-945-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36924207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053741Medicaid
CAW11782Medicare ID - Type Unspecified
CAGR0053741Medicaid
CAW11782AMedicare ID - Type Unspecified
CAA91835Medicare UPIN