Provider Demographics
NPI:1245240951
Name:GLINDMEYER, DAPHNE ANN (MD)
Entity Type:Individual
Prefix:MISS
First Name:DAPHNE
Middle Name:ANN
Last Name:GLINDMEYER
Suffix:
Gender:F
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:P.O. BOX 4240
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70434
Mailing Address - Country:US
Mailing Address - Phone:504-392-8348
Mailing Address - Fax:504-398-4334
Practice Address - Street 1:611 RIVERHIGHLANDS
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:504-392-8348
Practice Address - Fax:504-398-4334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10559R2084F0202X, 2084P0804X
LAMD.10559R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1682713Medicaid
IA5W610Medicare ID - Type Unspecified
LA1682713Medicaid