Provider Demographics
NPI:1427058205
Name:GLENCROSS, P MARK (MD MPH PA)
Entity type:Individual
Prefix:DR
First Name:P
Middle Name:MARK
Last Name:GLENCROSS
Suffix:
Gender:M
Credentials:MD MPH PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5868 WESTHEIMER RD
Mailing Address - Street 2:#312
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-5641
Mailing Address - Country:US
Mailing Address - Phone:904-476-1723
Mailing Address - Fax:866-548-6451
Practice Address - Street 1:3665 E BAY DR STE 204-22
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-1990
Practice Address - Country:US
Practice Address - Phone:979-393-0161
Practice Address - Fax:866-548-6451
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME56612208100000X, 202C00000X, 2081S0010X, 2083X0100X
TXN9706208100000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D9824Medicare ID - Type Unspecified
F01256Medicare UPIN