Provider Demographics
NPI:1235240870
Name:MORGAN, GLENN L (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:L
Last Name:MORGAN
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 1:17070 RED OAK DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2619
Mailing Address - Country:US
Mailing Address - Phone:281-444-0865
Mailing Address - Fax:281-444-6037
Practice Address - Street 1:17070 RED OAK DR
Practice Address - Street 2:SUITE 301
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2619
Practice Address - Country:US
Practice Address - Phone:281-444-0865
Practice Address - Fax:281-444-6037
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0606207VG0400X
LA019589207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN10018165Medicaid
TX111898602Medicaid
TN0096DNOtherBLUE CROSS BLUE SHIELD
LA1381748Medicaid
FL913214700Medicaid
TN111898602Medicaid
TN160056100Medicare ID - Type UnspecifiedRAIL ROAD
FL913214700Medicaid
TN10018165Medicaid