MEDICARE: BENJAMIN GLOVER MD

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	207R00000X	Internal Medicine Physician	00021580	AL

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	:	1932158201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN GLOVER MD

Provider Business Mailing Address
First Line	:	PO BOX 52007
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30355-0007
Country	:	US
Telephone Number	:	678-397-0060
Fax Number	:	678-397-0065

Provider Business Practice Location Address
First Line	:	3400 HIGHWAY 78 E
Second Line	:
City	:	JASPER
State	:	AL
Zip	:	35501-8956
Country	:	US
Telephone Number	:	205-387-4401
Fax Number	:	205-387-4717

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

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	07/08/2007

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