Provider Demographics
NPI:1427186485
Name:DAVID W. GLENN M.D. PA
Entity type:Organization
Organization Name:DAVID W. GLENN M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-639-2244
Mailing Address - Street 1:1111 W FRANK AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3390
Mailing Address - Country:US
Mailing Address - Phone:936-639-2244
Mailing Address - Fax:936-634-9334
Practice Address - Street 1:1111 W FRANK AVE STE 100
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3390
Practice Address - Country:US
Practice Address - Phone:936-639-2244
Practice Address - Fax:936-634-9334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179088301Medicaid
TX0064PYOtherBCBS
TXDG1275Medicare PIN
TX0064PYOtherBCBS