Healthcare Provider Details

I. General information

NPI: 1538103569
Provider Name (Legal Business Name): D. BRUCE GLOVER JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 5TH ST SUITE 328
WASHINGTON MO
63090-3135
US

IV. Provider business mailing address

851 E 5TH ST SUITE 328
WASHINGTON MO
63090-3135
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-1101
  • Fax:
Mailing address:
  • Phone: 636-239-1101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2007015927
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: