Healthcare Provider Details

I. General information

NPI: 1740566736
Provider Name (Legal Business Name): GLENN ALAN CARR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2011
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 E HERNDON AVE STE 850
FRESNO CA
93720-3309
US

IV. Provider business mailing address

7145 N CHESTNUT AVE STE 101
FRESNO CA
93720-0359
US

V. Phone/Fax

Practice location:
  • Phone: 559-450-5672
  • Fax:
Mailing address:
  • Phone: 559-455-7783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA164932
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA164932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: