Provider Demographics
NPI:1508050857
Name:GLYNN, PATRICK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:GLYNN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64301 HWY 434
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445
Mailing Address - Country:US
Mailing Address - Phone:985-882-4500
Mailing Address - Fax:985-882-4501
Practice Address - Street 1:64301 HWY 434
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445
Practice Address - Country:US
Practice Address - Phone:985-882-4500
Practice Address - Fax:985-882-4501
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2004522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1074128Medicaid
MS04956850Medicaid
LA4N093Medicare PIN