Provider Demographics
NPI:1245315498
Name:GLENN, DAVID WREN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:WREN
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 W FRANK AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3303
Mailing Address - Country:US
Mailing Address - Phone:936-639-2244
Mailing Address - Fax:936-634-9334
Practice Address - Street 1:1111 W FRANK AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3303
Practice Address - Country:US
Practice Address - Phone:936-639-2244
Practice Address - Fax:936-634-9334
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH0057207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ182OtherBLUE CROSS
TX8AJ182OtherBLUE CROSS
TX8F0157Medicare PIN
TXC16164Medicare UPIN