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General NPI Number Information
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NPI Number | 1790777563
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Entity Type | Individual
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Provider Name | JOHN S MCGLOTHLEN CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1200 E PECAN ST
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City | ALTUS
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State | OK
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Zip | 73521-6141
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Country | US
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Telephone | 580-477-7243
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Fax |
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Provider Business Mailing Address
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Address Line | 937 N COWBOY CANYON DR
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City | GREEN VALLEY
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State | AZ
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Zip | 85614-5546
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Country | US
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Telephone | 520-398-7481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R0031880
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License Number State | OK
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