Provider Demographics
NPI:1467647396
Name:GLENN FIGUEROA MD APMC
Entity Type:Organization
Organization Name:GLENN FIGUEROA MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-255-4076
Mailing Address - Street 1:411 E VAUGHN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5972
Mailing Address - Country:US
Mailing Address - Phone:318-255-4076
Mailing Address - Fax:318-255-8918
Practice Address - Street 1:411 E VAUGHN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5972
Practice Address - Country:US
Practice Address - Phone:318-255-4076
Practice Address - Fax:318-255-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD11020R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1664197Medicaid
LAG12159Medicare UPIN
LA1664197Medicaid