Provider Demographics
NPI:1467429050
Name:MACPHERSON, GLEN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:DOUGLAS
Last Name:MACPHERSON
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 1:9975 W OTTAWA AVE
Mailing Address - Street 2:
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630-9618
Mailing Address - Country:US
Mailing Address - Phone:231-835-2088
Mailing Address - Fax:231-835-2534
Practice Address - Street 1:9975 W OTTAWA AVE
Practice Address - Street 2:
Practice Address - City:EMPIRE
Practice Address - State:MI
Practice Address - Zip Code:49630-9618
Practice Address - Country:US
Practice Address - Phone:231-835-2088
Practice Address - Fax:231-835-2534
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106834207P00000X, 2083P0901X, 2083A0100X
IN01056456A2083A0100X
TXM94702083P0011X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine