Provider Demographics
NPI:1265437081
Name:GLENN, RICHARD L JR (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:GLENN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:L
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1215 DUFF AVENUE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4400
Mailing Address - Fax:515-239-4446
Practice Address - Street 1:1215 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5400
Practice Address - Country:US
Practice Address - Phone:515-239-6992
Practice Address - Fax:515-239-2007
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02789208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist