Healthcare Provider Details

I. General information

NPI: 1255332102
Provider Name (Legal Business Name): GLENN A WINSLOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 13TH AVE S STE 102
GREAT FALLS MT
59405-4300
US

IV. Provider business mailing address

PO BOX 6010
GREAT FALLS MT
59406-6010
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2171
  • Fax: 406-771-3021
Mailing address:
  • Phone: 406-731-8888
  • Fax: 406-731-8318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number8297
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: