Healthcare Provider Details

I. General information

NPI: 1902033210
Provider Name (Legal Business Name): ROBERT CLIFTON GLENN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W REDLANDS BLVD STE B
REDLANDS CA
92373-4642
US

IV. Provider business mailing address

2319 SAINT MATTHEWS RD
ORANGEBURG SC
29118-2042
US

V. Phone/Fax

Practice location:
  • Phone: 909-686-6233
  • Fax: 909-353-4985
Mailing address:
  • Phone: 803-536-1571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31737
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101276604
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number332429
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2022-02060
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: