Provider Demographics
NPI:1710052105
Name:MCALPIN, GLENN MARK (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:MARK
Last Name:MCALPIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-229-5833
Mailing Address - Fax:850-229-5832
Practice Address - Street 1:3871 E HIGHWAY 98
Practice Address - Street 2:SUITE 203
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-5301
Practice Address - Country:US
Practice Address - Phone:850-229-5833
Practice Address - Fax:850-229-5832
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME126137208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00590477AMedicaid
02BDCJCMedicare ID - Type Unspecified
B46434Medicare UPIN