Healthcare Provider Details

I. General information

NPI: 1811525017
Provider Name (Legal Business Name): GLYNN RIELS JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E VAUGHN AVE
RUSTON LA
71270-5950
US

IV. Provider business mailing address

401 E VAUGHN AVE
RUSTON LA
71270-5950
US

V. Phone/Fax

Practice location:
  • Phone: 318-254-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-16443
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340086
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: