MEDICARE: GLENN D PABODY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA02385	TX
2	363A00000X	Physician Assistant	PA02385	TX

General Provider Information

NPI Number	:	1053414938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN D PABODY PA

Provider Business Mailing Address
First Line	:	12377 MERIT DR STE 300
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-3126
Country	:	US
Telephone Number	:	972-957-3000
Fax Number	:	972-957-3005

Provider Business Practice Location Address
First Line	:	2815 S HAMPTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-2329
Country	:	US
Telephone Number	:	214-330-0137
Fax Number	:	214-333-7343

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	04/18/2023

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