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NPI Code Detail

MEDICARE: GARY L GLYNN DPM INC.

MEDICARE: GARY L GLYNN DPM INC.
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
1213E00000XPodiatrist36002779OH

Other Identifiers

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

General Provider Information

NPI Number : 1336263490
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARY L GLYNN DPM INC.
Provider Business Mailing Address
First Line : 6200 PLEASANT AVE
Second Line : SUITE 3
City : FAIRFIELD
State : OH
Zip : 45014-4670
Country : US
Telephone Number : 513-829-9333
Fax Number :
Provider Business Practice Location Address
First Line : 6200 PLEASANT AVE
Second Line : SUITE 3
City : FAIRFIELD
State : OH
Zip : 45014-4670
Country : US
Telephone Number : 513-829-9333
Fax Number :
Authorized Official
Title or Position : DPM OWNER
Name : GARY L GLYNN
Credential :
Telephone Number : 513-825-2224
Provider Enumeration Date : 03/16/2007
Last Update Date : 07/23/2014

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Directions to “GARY L GLYNN DPM INC. ” Practice Location

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