Healthcare Provider Details

I. General information

NPI: 1992094908
Provider Name (Legal Business Name): DREW WASHINGTON GLOVER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 06/11/2021
Certification Date: 06/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 E. RUSSELL BUILDING C
WARRENSBURG MO
64093
US

IV. Provider business mailing address

407 E. RUSSELL BUILDING C
WARRENSBURG MO
64093
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-5114
  • Fax: 660-747-8582
Mailing address:
  • Phone: 660-747-5114
  • Fax: 660-747-8582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2012030855
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2012030855
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: