Provider Demographics
NPI:1942302211
Name:GLENN, CLAIR JOSEPH (MD, OB/GYN)
Entity Type:Individual
Prefix:DR
First Name:CLAIR
Middle Name:JOSEPH
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD, OB/GYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 N 300 W STE 110
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3381
Mailing Address - Country:US
Mailing Address - Phone:801-357-7377
Mailing Address - Fax:801-357-7378
Practice Address - Street 1:1055 N 300 W STE 110
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3381
Practice Address - Country:US
Practice Address - Phone:801-357-7377
Practice Address - Fax:801-357-7378
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-10-05
Deactivation Date:2023-07-31
Deactivation Code:
Reactivation Date:2023-10-05
Provider Licenses
StateLicense IDTaxonomies
UT172886-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD26589Medicare UPIN
UT000002996Medicare ID - Type UnspecifiedMEDICARE - C JOSEPH GLENN