Provider Demographics
NPI:1720125149
Name:GLOSSBRENNER, DAVID FORKER (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:FORKER
Last Name:GLOSSBRENNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2264 FOXHILL PL
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-8123
Mailing Address - Country:US
Mailing Address - Phone:559-240-1660
Mailing Address - Fax:559-585-8440
Practice Address - Street 1:2264 FOXHILL PL
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-8123
Practice Address - Country:US
Practice Address - Phone:559-240-1660
Practice Address - Fax:559-585-8440
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50054207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE25288Medicare UPIN