Healthcare Provider Details

I. General information

NPI: 1508050857
Provider Name (Legal Business Name): PATRICK JOSEPH GLYNN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64301 HWY 434
LACOMBE LA
70445
US

IV. Provider business mailing address

64301 HWY 434
LACOMBE LA
70445
US

V. Phone/Fax

Practice location:
  • Phone: 985-882-4500
  • Fax: 985-882-4501
Mailing address:
  • Phone: 985-882-4500
  • Fax: 985-882-4501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number200452
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: