Provider Demographics
NPI:1184859720
Name:GLENN, JAMES ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:GLENN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2224 NW 50TH ST
Mailing Address - Street 2:SUITE 276W
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8046
Mailing Address - Country:US
Mailing Address - Phone:405-858-2350
Mailing Address - Fax:405-858-2365
Practice Address - Street 1:2224 NW 50TH ST
Practice Address - Street 2:SUITE 276W
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8046
Practice Address - Country:US
Practice Address - Phone:405-858-2350
Practice Address - Fax:405-858-2365
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OK49042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program