Provider Demographics
NPI:1326052911
Name:GLENN, JANICE S (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:S
Last Name:GLENN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2600 BELLE CHASSE HIGHWAY
Mailing Address - Street 2:SUITE 201 A
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7156
Mailing Address - Country:US
Mailing Address - Phone:504-391-1087
Mailing Address - Fax:504-391-1073
Practice Address - Street 1:2600 BELLE CHASSE HIGHWAY
Practice Address - Street 2:SUITE 201 A
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7156
Practice Address - Country:US
Practice Address - Phone:504-391-1087
Practice Address - Fax:504-391-1073
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08593R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1910104Medicaid
LA5N361Medicare ID - Type Unspecified
LAA48640Medicare UPIN