Provider Demographics
NPI:1255309449
Name:MCDERMOTT, GLENN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:DAVID
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Mailing Address - Street 2:9040 REID ST; ATTN: MCHJ-QCR
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-2252
Mailing Address - Fax:253-968-3278
Practice Address - Street 1:MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:9040 REID ST; ATTN: MCHJ-QCR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
UT182618-12052083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine