Provider Demographics
NPI:1336149434
Name:GLENN, STEPHEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:GLENN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5658
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:2600 SAINT MICHAEL DR
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5220
Practice Address - Country:US
Practice Address - Phone:903-614-5111
Practice Address - Fax:903-614-5114
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF5920208M00000X, 207R00000X
ARR3803207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR114425001Medicaid
TX116232302Medicaid
TX8AN228OtherBCBS OF TEXAS
TXP00830978OtherRR MEDICARE
TX116232304Medicaid
OK100167150AMedicaid
TX89E331Medicare ID - Type Unspecified
OK100167150AMedicaid
TX8L15791Medicare PIN