Provider Demographics
NPI:1356662415
Name:GLENN, CHAD (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 NW 9TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-7248
Mailing Address - Country:US
Mailing Address - Phone:405-815-5050
Mailing Address - Fax:405-815-5051
Practice Address - Street 1:800 NW 9TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7248
Practice Address - Country:US
Practice Address - Phone:405-815-5050
Practice Address - Fax:405-815-5051
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK27877207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery