Healthcare Provider Details

I. General information

NPI: 1124604129
Provider Name (Legal Business Name): BRANDON GREGORY GLOVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2021
Last Update Date: 10/08/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 PINE ST
FRANKLIN WV
26807-6630
US

IV. Provider business mailing address

82 PINE ST
FRANKLIN WV
26807-6630
US

V. Phone/Fax

Practice location:
  • Phone: 304-358-2355
  • Fax: 855-332-1388
Mailing address:
  • Phone: 304-358-2355
  • Fax: 855-332-1388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32709
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: