Provider Demographics
NPI:1144219015
Name:EINSPANIER, GLENNON RAYMOND JR (MD)
Entity Type:Individual
Prefix:
First Name:GLENNON
Middle Name:RAYMOND
Last Name:EINSPANIER
Suffix:JR
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 1:2300 S CLEAR CREEK RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-4984
Mailing Address - Country:US
Mailing Address - Phone:855-963-4325
Mailing Address - Fax:855-963-4325
Practice Address - Street 1:2300 S CLEAR CREEK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-4984
Practice Address - Country:US
Practice Address - Phone:254-634-4325
Practice Address - Fax:254-200-2921
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0024208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100354301Medicaid
TX86Y909Medicare ID - Type Unspecified
TX86Y909Medicare PIN
TX100354301Medicaid