Provider Demographics
NPI:1205822962
Name:GLOVER, DANNIE W (MD)
Entity Type:Individual
Prefix:DR
First Name:DANNIE
Middle Name:W
Last Name:GLOVER
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 1:1550 SPARTA STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-1317
Mailing Address - Country:US
Mailing Address - Phone:931-474-8005
Mailing Address - Fax:
Practice Address - Street 1:1550 SPARTA ST STE 7
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1315
Practice Address - Country:US
Practice Address - Phone:931-474-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN8901754OtherBC/BS TENNESSEE
TN3853870Medicare PIN
B04390Medicare UPIN
B04390Medicare UPIN
080184014OtherRAILROAD MEDICARE
TN3853878Medicaid