Healthcare Provider Details

I. General information

NPI: 1831252287
Provider Name (Legal Business Name): GARY R GLYNN MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FOUCHER STREET SUITE M1005
NEW ORLEANS LA
70115
US

IV. Provider business mailing address

1401 FOUCHER STREET SUITE M1005
NEW ORLEANS LA
70115
US

V. Phone/Fax

Practice location:
  • Phone: 504-897-8543
  • Fax: 504-897-8726
Mailing address:
  • Phone: 504-897-8543
  • Fax: 504-897-8726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA SERRONE
Title or Position: OFFICE MANAGER
Credential:
Phone: 504-897-8543