Provider Demographics
NPI:1487045951
Name:GLENN DONALD GARBUTT, M.D., INC
Entity Type:Organization
Organization Name:GLENN DONALD GARBUTT, M.D., INC
Other - Org Name:VALLEY NEPHROLOGY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR/LIAISON
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:CHARRON-GARBUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-476-1934
Mailing Address - Street 1:1381 E HERNDON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3307
Mailing Address - Country:US
Mailing Address - Phone:559-448-8481
Mailing Address - Fax:
Practice Address - Street 1:1381 E HERNDON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3307
Practice Address - Country:US
Practice Address - Phone:559-448-8481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-05
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13844174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ99970ZOtherMEDICARE PTAN