Provider Demographics
NPI:1982822375
Name:GLOVER, ROOSEVELT VIRGIL JR (BACHELOR SCIENCE(BS))
Entity Type:Individual
Prefix:MR
First Name:ROOSEVELT
Middle Name:VIRGIL
Last Name:GLOVER
Suffix:JR
Gender:M
Credentials:BACHELOR SCIENCE(BS)
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:904 S WALDEN WAY
Mailing Address - Street 2:#101
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-3492
Mailing Address - Country:US
Mailing Address - Phone:303-751-0230
Mailing Address - Fax:
Practice Address - Street 1:6507 S SANTA FE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-2910
Practice Address - Country:US
Practice Address - Phone:303-730-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2009Medicare ID - Type UnspecifiedGROUP NUMBER