Provider Demographics
NPI:1073641973
Name:MARTIN S GLORE MD PA
Entity Type:Organization
Organization Name:MARTIN S GLORE MD PA
Other - Org Name:THE PAIN CARE INSTITUTE PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-682-8588
Mailing Address - Street 1:PO BOX 5669
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5669
Mailing Address - Country:US
Mailing Address - Phone:956-682-8588
Mailing Address - Fax:956-682-8233
Practice Address - Street 1:2719 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3433
Practice Address - Country:US
Practice Address - Phone:956-682-8588
Practice Address - Fax:956-682-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9054174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1831197185Medicaid
TX117159702Medicaid
TX8A1370OtherBCBS
TX079601301Medicaid
TX1831197185Medicaid