MEDICARE: DR. ROSALIND MARIE GLENN M.D.

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	H0058	TX

General Provider Information

NPI Number	:	1518004423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSALIND MARIE GLENN M.D.

Provider Business Mailing Address
First Line	:	4209 EAGLE RIDGE DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4615
Country	:	US
Telephone Number	:	817-438-1070
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 SE LOOP 820
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76140-1108
Country	:	US
Telephone Number	:	817-483-1070
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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