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NPI Code Detail

MEDICARE: DR. GLENN MARTIN HALUSKA M.D.

MEDICARE: DR. GLENN MARTIN HALUSKA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology PhysicianF2275TX

General Provider Information

NPI Number : 1083634877
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLENN MARTIN HALUSKA M.D.
Provider Business Mailing Address
First Line : 2100 RIDGEWOOD DR
Second Line :
City : WACO
State : TX
Zip : 76710-6103
Country : US
Telephone Number : 254-772-3701
Fax Number :
Provider Business Practice Location Address
First Line : 3000 HERRING AVE
Second Line :
City : WACO
State : TX
Zip : 76708-3239
Country : US
Telephone Number : 254-202-8675
Fax Number : 254-202-6669
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2006
Last Update Date : 07/08/2007

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