Provider Demographics
NPI:1417949637
Name:GLENN, RONALD EDWARD JR (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EDWARD
Last Name:GLENN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:EDWARD
Other - Last Name:GLENN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:615-329-2294
Mailing Address - Fax:615-695-1494
Practice Address - Street 1:4230 HARDING PIKE STE 1000
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2098
Practice Address - Country:US
Practice Address - Phone:615-383-2693
Practice Address - Fax:615-297-1449
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD39998207XX0005X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3330672Medicaid
TNI22302Medicare UPIN
TN0406260002Medicare NSC