Provider Demographics
NPI:1154390581
Name:GLOECKNER, EARL G (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:G
Last Name:GLOECKNER
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 1:1420 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-2916
Mailing Address - Country:US
Mailing Address - Phone:309-762-2333
Mailing Address - Fax:309-762-8001
Practice Address - Street 1:1420 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-2916
Practice Address - Country:US
Practice Address - Phone:309-762-2333
Practice Address - Fax:309-762-8001
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08100437OtherBC/BS
ILA14601Medicare UPIN
IL08100437OtherBC/BS