MEDICARE: GLENNON RAYMOND EINSPANIER JR. 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
1	208600000X	Surgery Physician	K0024	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144219015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENNON RAYMOND EINSPANIER JR. M.D.

Provider Business Mailing Address
First Line	:	2300 S CLEAR CREEK RD
Second Line	:	SUITE 101
City	:	KILLEEN
State	:	TX
Zip	:	76549-4984
Country	:	US
Telephone Number	:	855-963-4325
Fax Number	:	855-963-4325

Provider Business Practice Location Address
First Line	:	2300 S CLEAR CREEK RD
Second Line	:	SUITE 101
City	:	KILLEEN
State	:	TX
Zip	:	76549-4984
Country	:	US
Telephone Number	:	254-634-4325
Fax Number	:	254-200-2921

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	05/16/2014

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