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General NPI Number Information
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NPI Number | 1932157542
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Entity Type | Individual
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Provider Name | BRIAN J GLYMPH MD
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4800 NE STALLINGS DR SUITE 106
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1249
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Country | US
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Telephone | 939-569-0000
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Fax | 936-560-4932
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Provider Business Mailing Address
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Address Line | 4800 NE STALLINGS DR SUITE 106
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1249
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Country | US
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Telephone | 939-569-0000
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Fax | 936-560-4932
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | L3976
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License Number State | TX
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