Provider Demographics
NPI:1033385810
Name:ROPER, GLADE E (MD)
Entity Type:Individual
Prefix:
First Name:GLADE
Middle Name:E
Last Name:ROPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1700 S COURT ST STE F
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-4931
Mailing Address - Country:US
Mailing Address - Phone:559-734-9244
Mailing Address - Fax:559-734-6932
Practice Address - Street 1:1700 S COURT ST STE A
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4931
Practice Address - Country:US
Practice Address - Phone:559-734-9244
Practice Address - Fax:559-734-6932
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1013072085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z145579Medicare PIN