Provider Demographics
NPI:1124604129
Name:GLOVER, BRANDON GREGORY (MD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:GREGORY
Last Name:GLOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 PINE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WV
Mailing Address - Zip Code:26807-6630
Mailing Address - Country:US
Mailing Address - Phone:304-358-2355
Mailing Address - Fax:855-332-1388
Practice Address - Street 1:82 PINE ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WV
Practice Address - Zip Code:26807-6630
Practice Address - Country:US
Practice Address - Phone:304-358-2355
Practice Address - Fax:855-332-1388
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32709207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine