Provider Demographics
NPI:1184949505
Name:GLADNICK, BRIAN P (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:P
Last Name:GLADNICK
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 1:9301 N CENTRAL EXPY STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0805
Mailing Address - Country:US
Mailing Address - Phone:214-220-2468
Mailing Address - Fax:214-720-1982
Practice Address - Street 1:9301 N CENTRAL EXPY STE 500
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0805
Practice Address - Country:US
Practice Address - Phone:214-220-2468
Practice Address - Fax:214-720-1982
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-00024207X00000X
TXR9066207X00000X
VA0101259323207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2395Medicaid
NC1184949505Medicaid
NC0397730024Medicare NSC
NCNCN180AMedicare PIN