Provider Demographics
NPI:1437149408
Name:FIGUEROA, GLENN R (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:R
Last Name:FIGUEROA
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 1:206 MCMILLAN RD
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5322
Mailing Address - Country:US
Mailing Address - Phone:318-855-4062
Mailing Address - Fax:318-855-4075
Practice Address - Street 1:206 MCMILLAN RD
Practice Address - Street 2:SUITE # 1
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5322
Practice Address - Country:US
Practice Address - Phone:318-855-4062
Practice Address - Fax:318-855-4075
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN69216207R00000X
ND13919207R00000X
WI68491208M00000X
LAMD.11020R207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1664197Medicaid
LA5CG81Medicare ID - Type Unspecified
LAG12159Medicare UPIN
NDN722329Medicare PIN
NDN722328Medicare PIN