Provider Demographics
NPI:1023024254
Name:GLYNN, JAMES J (MD,)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:GLYNN
Suffix:
Gender:M
Credentials:MD,
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Mailing Address - Street 1:1496 PROFESSIONAL DRIVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-778-1131
Mailing Address - Fax:707-778-3818
Practice Address - Street 1:1496 PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 601
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-778-1131
Practice Address - Fax:707-778-3818
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-11-27
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Provider Licenses
StateLicense IDTaxonomies
CAG22422207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1023024254OtherNPI
CADL687ZOtherPTAN