MEDICARE: DR. DANNIE W GLOVER MD

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	207Q00000X	Family Medicine Physician	MD13404	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8901754	OTHER	TN	BC/BS TENNESSEE

General Provider Information

NPI Number	:	1205822962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNIE W GLOVER MD

Provider Business Mailing Address
First Line	:	1550 SPARTA STREET
Second Line	:	SUITE 7
City	:	MC MINNVILLE
State	:	TN
Zip	:	37110-1317
Country	:	US
Telephone Number	:	931-474-8005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 SPARTA ST STE 7
Second Line	:
City	:	MCMINNVILLE
State	:	TN
Zip	:	37110-1315
Country	:	US
Telephone Number	:	931-474-8005
Fax Number	:

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

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	12/07/2017

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