Provider Demographics
NPI:1699778092
Name:GLENN, JAMES N (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:N
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1130 OXFORD DRIVE
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801
Mailing Address - Country:US
Mailing Address - Phone:620-343-1508
Mailing Address - Fax:620-343-3139
Practice Address - Street 1:1301 W 12TH AVE
Practice Address - Street 2:STE 105
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-2588
Practice Address - Country:US
Practice Address - Phone:620-343-1191
Practice Address - Fax:620-343-3139
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-14326207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B68364Medicare UPIN
KS054400Medicare ID - Type Unspecified