Provider Demographics
NPI:1619046661
Name:HOUSER, GLENN D (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:D
Last Name:HOUSER
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:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-2069
Mailing Address - Country:US
Mailing Address - Phone:406-297-3145
Mailing Address - Fax:406-297-3364
Practice Address - Street 1:450 OSLOSKI RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9534
Practice Address - Country:US
Practice Address - Phone:406-297-3145
Practice Address - Fax:406-297-3364
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0024793146N00000X
MT11439207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1619046661OtherNPI
WAF03129Medicare UPIN