Provider Demographics
NPI:1376674341
Name:GLOVER, JOHN CHARLES (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:GLOVER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1310 CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592
Mailing Address - Country:US
Mailing Address - Phone:707-638-5205
Mailing Address - Fax:707-638-5225
Practice Address - Street 1:365 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5700
Practice Address - Country:US
Practice Address - Phone:707-784-2001
Practice Address - Fax:707-784-1494
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6532204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE96528Medicare UPIN