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General NPI Number Information
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NPI Number | 1932412277
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Entity Type | Individual
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Provider Name | GLENN R VALE BSMT, MSM, MBA
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Gender | Male
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 1919 S SHILOH RD
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City | GARLAND
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State | TX
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Zip | 75042-8234
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Country | US
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Telephone | 972-864-0077
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Fax | 972-864-0079
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Provider Business Mailing Address
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Address Line | 1919 S SHILOH RD
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City | GARLAND
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State | TX
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Zip | 75042-8234
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Country | US
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Telephone | 972-864-0077
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Fax | 972-864-0079
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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 | 246QM0706X
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Taxonomy Name | Medical Technologist
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License Number |
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License Number State | TX
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