Provider Demographics
NPI:1346230364
Name:HINCHMAN, GLENN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:HINCHMAN
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 1:10679 N FRANK LLOYD WRIGHT BLVD
Mailing Address - Street 2:STE #101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2658
Mailing Address - Country:US
Mailing Address - Phone:480-314-5365
Mailing Address - Fax:480-314-5370
Practice Address - Street 1:10679 N FRANK LLOYD WRIGHT BLVD
Practice Address - Street 2:STE #101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2658
Practice Address - Country:US
Practice Address - Phone:480-314-5365
Practice Address - Fax:480-314-5370
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25523207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ39885Medicaid
AZ39885Medicaid
67375Medicare PIN
AZG58308Medicare UPIN
119308Medicare PIN
AZG58308Medicare UPIN