Provider Demographics
NPI:1053316349
Name:GLUCK, WILLIAM LARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LARRY
Last Name:GLUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6303
Mailing Address - Fax:
Practice Address - Street 1:3 BUTTERNUT DR
Practice Address - Street 2:STE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4653
Practice Address - Country:US
Practice Address - Phone:864-298-2826
Practice Address - Fax:864-672-7764
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12745207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC127455Medicaid
SC6526Medicare PIN
SC127455Medicaid
SCC601987951Medicare PIN