Provider Demographics
NPI:1457906596
Name:GLAVES, JOHN ROBERT
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:GLAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21750 MEAGHER RD
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:KS
Mailing Address - Zip Code:66020-7315
Mailing Address - Country:US
Mailing Address - Phone:913-773-8184
Mailing Address - Fax:
Practice Address - Street 1:21750 MEAGHER RD
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:KS
Practice Address - Zip Code:66020-7315
Practice Address - Country:US
Practice Address - Phone:913-773-8184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider