NPI Code Detail JSON Logo

1487044608 NPI number — KEITH GLENN MD

NPI Number: 1487044608
Health Care Provider/Practitioner: KEITH GLENN MD

Information about “1487044608” NPI (KEITH GLENN MD) exists in 1487044608 in HTML format HTML  |  1487044608 in plain Text format TXT  |  1487044608 in PDF (Portable Document Format) PDF  |  1487044608 in an XML format XML  formats.

NPI Number : 1487044608 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1487044608",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GLENN",
    "FirstName": "KEITH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GLENN",
    "OtherFirstName": "KEITH",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3551 ROGER BROOKE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT SAM HOUSTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78234-4504",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "210-539-9582",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3551 ROGER BROOKE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT SAM HOUSTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78234-4504",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-539-9582",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/26/2015",
    "LastUpdateDate": "03/11/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RI0200X",
          "TaxonomyName": "Infectious Disease Physician",
          "LicenseNumber": "35.133298",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "35.133298",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RC0200X",
          "TaxonomyName": "Critical Care Medicine (Internal Medicine) Physician",
          "LicenseNumber": "35.133298",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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