Provider Demographics
NPI:1396954236
Name:GLEGHORN, ALAN DEAN (TRANSPORTATION)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:DEAN
Last Name:GLEGHORN
Suffix:
Gender:M
Credentials:TRANSPORTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 N TIBBS AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-3026
Mailing Address - Country:US
Mailing Address - Phone:317-634-1316
Mailing Address - Fax:317-634-0631
Practice Address - Street 1:1424 N TIBBS AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-3026
Practice Address - Country:US
Practice Address - Phone:317-634-1316
Practice Address - Fax:317-634-0631
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8908-42-9702172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver