MEDICARE: DR. GLENN AMANTE PACIO 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	207R00000X	Internal Medicine Physician	MD00038095	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00183687	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	658809001	OTHER	WA	GROUP HEALTH
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497755268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN AMANTE PACIO MD

Provider Business Mailing Address
First Line	:	7501 92ND AVENUE CT SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-3973
Country	:	US
Telephone Number	:	253-588-0058
Fax Number	:	253-589-4862

Provider Business Practice Location Address
First Line	:	7501 92ND AVENUE CT SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-3973
Country	:	US
Telephone Number	:	253-588-0058
Fax Number	:	253-589-4862

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	04/09/2015

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