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NPI Code Detail

MEDICARE: GLENN THOMAS ORSAK M.D.

MEDICARE: GLENN THOMAS ORSAK 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
1207Q00000XFamily Medicine PhysicianJ7827TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1J7827OTHERTXSTATE LICENSE

General Provider Information

NPI Number : 1174528822
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENN THOMAS ORSAK M.D.
Provider Business Mailing Address
First Line : 300 E EDGEWOOD DR
Second Line :
City : FRIENDSWOOD
State : TX
Zip : 77546-3823
Country : US
Telephone Number : 281-485-9034
Fax Number : 281-485-9807
Provider Business Practice Location Address
First Line : 300 E EDGEWOOD DR
Second Line :
City : FRIENDSWOOD
State : TX
Zip : 77546-3823
Country : US
Telephone Number : 281-485-9034
Fax Number : 281-485-9807
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2005
Last Update Date : 08/13/2020

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