Provider Demographics
NPI:1235257049
Name:GLICK, DAVID GEORG (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORG
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5091 WESTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-0231
Mailing Address - Country:US
Mailing Address - Phone:818-784-9304
Mailing Address - Fax:818-784-9307
Practice Address - Street 1:16101 VENTURA BLVD STE 240
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2513
Practice Address - Country:US
Practice Address - Phone:818-784-9304
Practice Address - Fax:818-784-9307
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG53604208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery