Provider Demographics
NPI:1609080589
Name:GLINTON, LUIS ALEXANDER (IDC)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ALEXANDER
Last Name:GLINTON
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 KENNY LN
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2637
Mailing Address - Country:US
Mailing Address - Phone:760-429-8870
Mailing Address - Fax:
Practice Address - Street 1:NORFOLK NAVAL SHIPYARD
Practice Address - Street 2:BLDG 15
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23709
Practice Address - Country:US
Practice Address - Phone:757-967-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman