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General NPI Number Information
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NPI Number | 1972990174
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Entity Type | Individual
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Provider Name | TERRELL GLENN MD
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Gender | Male
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Dates
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Enumeration Date | 04/25/2015
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 2965 W 3500 S
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3602
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Country | US
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Telephone | 801-965-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 2965 W 3500 S
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City | WEST VALLEY CITY
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State | UT
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Zip | 84119-3602
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Country | US
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Telephone | 801-965-3600
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | R0578
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD189449
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 11929964-1205
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License Number State | UT
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