Healthcare Provider Details

I. General information

NPI: 1922299361
Provider Name (Legal Business Name): BRION A. GLUCK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N MESA ST STE 200
EL PASO TX
79902-3554
US

IV. Provider business mailing address

1800 N MESA ST STE 200
EL PASO TX
79902-3554
US

V. Phone/Fax

Practice location:
  • Phone: 915-577-9900
  • Fax: 915-577-0200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberH9954
License Number StateTX

VIII. Authorized Official

Name: DR. BRION A GLUCK
Title or Position: OWNER
Credential: MD
Phone: 915-577-9900