Healthcare Provider Details

I. General information

NPI: 1336399401
Provider Name (Legal Business Name): DONALD K. GLOVER, D.O., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657A W MAPLE ST
FARMINGTON NM
87401-5967
US

IV. Provider business mailing address

657A W MAPLE ST
FARMINGTON NM
87401-5967
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-4546
  • Fax: 505-325-0689
Mailing address:
  • Phone: 505-326-4546
  • Fax: 505-325-0689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA76683
License Number StateNM

VIII. Authorized Official

Name: DONALD K GLOVER JR.
Title or Position: PRESIDENT
Credential: D.O.
Phone: 505-326-4546