Healthcare Provider Details

I. General information

NPI: 1962518167
Provider Name (Legal Business Name): CHRISTOPHER GLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 S SONCY RD STE 104
AMARILLO TX
79119-6405
US

IV. Provider business mailing address

PO BOX 3046
MALVERN PA
19355-0746
US

V. Phone/Fax

Practice location:
  • Phone: 806-398-3627
  • Fax: 806-351-7801
Mailing address:
  • Phone: 806-398-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberR6195
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberR6195
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: