Provider Demographics
NPI:1629015813
Name:GLOVER, JASON PHILLIP (DPM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:PHILLIP
Last Name:GLOVER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 DOCTOR HENRY NORRIS DR
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-3176
Mailing Address - Country:US
Mailing Address - Phone:828-287-9260
Mailing Address - Fax:828-287-9709
Practice Address - Street 1:139 DOCTOR HENRY NORRIS DR
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-3176
Practice Address - Country:US
Practice Address - Phone:828-287-9260
Practice Address - Fax:828-287-9709
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005324213E00000X
OH36-00-3422213ES0103X
NC511213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910207Medicaid
ILK39744Medicare PIN
NC5910207Medicaid
NC2430013Medicare PIN