Provider Demographics
NPI:1992719371
Name:ROUGEOU, GLENDON P (MD)
Entity type:Individual
Prefix:DR
First Name:GLENDON
Middle Name:P
Last Name:ROUGEOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 CALIFORNIA ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-5424
Mailing Address - Country:US
Mailing Address - Phone:415-504-3838
Mailing Address - Fax:415-504-1367
Practice Address - Street 1:1 CALIFORNIA ST STE 2300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5424
Practice Address - Country:US
Practice Address - Phone:415-504-3838
Practice Address - Fax:415-504-1367
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036159042207Q00000X
WAMD61258786207Q00000X
TXT6468207Q00000X
IAMD-49368207Q00000X
AZ65671207Q00000X
GA070764207Q00000X
KY52347207Q00000X
SC87337207Q00000X
LA329649207Q00000X
FLME138774207Q00000X
NV21854207Q00000X
CODR.0060480207Q00000X
PAMD466294207Q00000X
CT62246207Q00000X
TN58719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907241Medicaid
NC2065113Medicare PIN