Provider Demographics
NPI:1942255161
Name:BIXLER, GLENN GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:GEORGE
Last Name:BIXLER
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 206204
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-6204
Mailing Address - Country:US
Mailing Address - Phone:817-228-0929
Mailing Address - Fax:
Practice Address - Street 1:425 ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-1022
Practice Address - Country:US
Practice Address - Phone:817-820-3400
Practice Address - Fax:817-887-5820
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3372208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063BAOtherBCBS
TX139224315Medicaid
TX0063BAMedicare PIN
TX0063BAOtherBCBS
TX139224315Medicaid