Provider Demographics
NPI:1417971102
Name:GLYNN, MATTHEW DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DAVID
Last Name:GLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:920 SW LANE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1543
Mailing Address - Country:US
Mailing Address - Phone:785-233-0500
Mailing Address - Fax:785-233-0660
Practice Address - Street 1:920 SW LANE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1543
Practice Address - Country:US
Practice Address - Phone:785-233-0500
Practice Address - Fax:785-233-0660
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-05-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0429018207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS102449OtherBLUE CROSS BLUE SHIELD
KS100391250BMedicaid
KS100391250BMedicaid
KSH36092Medicare UPIN