Healthcare Provider Details

I. General information

NPI: 1316910128
Provider Name (Legal Business Name): GLENN M UBER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 INNOVATION DR SUITE 101
SLIPPERY ROCK PA
16057
US

IV. Provider business mailing address

PO BOX 1549 BUTLER MEDICAL PROVIDERS
BUTLER PA
16003-1549
US

V. Phone/Fax

Practice location:
  • Phone: 724-794-4023
  • Fax: 724-794-3675
Mailing address:
  • Phone: 724-794-4023
  • Fax: 724-794-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS017368
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: