Provider Demographics
NPI:1962518167
Name:GLOCK, CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:GLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:806-398-3627
Mailing Address - Fax:
Practice Address - Street 1:3501 S SONCY RD STE 104
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-398-3627
Practice Address - Fax:806-351-7801
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6195207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000374076OtherANTHEM
IL036096337OtherILLINOIS PUBLIC AID
2477674OtherCIGNA
5518300OtherAETNA ASSIGNED
351904269199OtherCARESOURCE
464996OtherHEALTHLINK
IN200531820AMedicaid
P00268084OtherRAILROAD MCARE PALAMETTO
IN200531820TMedicaid
N304553OtherHARMONY HEALTH PLAN IND
351904269199OtherCARESOURCE
N304553OtherHARMONY HEALTH PLAN IND
IN200531820TMedicaid