Healthcare Provider Details

I. General information

NPI: 1063513737
Provider Name (Legal Business Name): GLENN DONALD GARBUTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 E HERNDON AVE STE 102
FRESNO CA
93720-3164
US

IV. Provider business mailing address

1381 E HERNDON AVE SUITE 102
FRESNO CA
93720-3307
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-8481
  • Fax: 559-448-0996
Mailing address:
  • Phone: 559-448-8481
  • Fax: 559-448-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG13844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: