Provider Demographics
NPI:1740398528
Name:GLYNN, GARY R (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:R
Last Name:GLYNN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 FOUCHER STREET
Mailing Address - Street 2:M1005
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115
Mailing Address - Country:US
Mailing Address - Phone:504-897-8543
Mailing Address - Fax:504-897-8726
Practice Address - Street 1:1401 FOUCHER STREET
Practice Address - Street 2:M1005
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115
Practice Address - Country:US
Practice Address - Phone:504-897-8543
Practice Address - Fax:504-897-8726
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2013-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA12725208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1301680Medicaid
LA52784F669Medicare PIN
LA52784Medicare PIN
B64131Medicare UPIN