Healthcare Provider Details

I. General information

NPI: 1104162270
Provider Name (Legal Business Name): MORRIS B GLOVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 SUNSET CANYON PL NE
ALBUQUERQUE NM
87111-3061
US

IV. Provider business mailing address

4514 SUNSET CANYON PL NE
ALBUQUERQUE NM
87111-3061
US

V. Phone/Fax

Practice location:
  • Phone: 505-296-5923
  • Fax:
Mailing address:
  • Phone: 505-296-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number69-136
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: