Provider Demographics
NPI:1467450957
Name:HILBORN, GLEN A (MD)
Entity type:Individual
Prefix:DR
First Name:GLEN
Middle Name:A
Last Name:HILBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:990 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2851
Mailing Address - Country:US
Mailing Address - Phone:360-479-3657
Mailing Address - Fax:360-373-7616
Practice Address - Street 1:990 SYLVAN WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2851
Practice Address - Country:US
Practice Address - Phone:360-479-3657
Practice Address - Fax:360-373-7616
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029734207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA910847215OtherUNIFORM MEDICAL
WA050039857OtherRAILROAD MEDICARE
WA91084721522OtherKPS
WA016487001OtherGROUP HEALTH CORP
WA910847215OtherPREMERA BLUE CROSS
WAHI5069OtherREGENCE BLUE SHIELD
WA79590OtherLABOR AND INDUSTRIES
WA8140865Medicaid
WA8927302OtherVICTIMS OF CRIME
WA910847215OtherUNIFORM MEDICAL
WA016487001OtherGROUP HEALTH CORP