Provider Demographics
NPI:1588728596
Name:SHIPLEY, GLENN MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:MICHAEL
Last Name:SHIPLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:701 W 51ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2312
Mailing Address - Country:US
Mailing Address - Phone:512-438-3086
Mailing Address - Fax:
Practice Address - Street 1:3401 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1734
Practice Address - Country:US
Practice Address - Phone:806-741-3609
Practice Address - Fax:806-741-3604
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0586432083P0500X
TXJ36072083C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine