Provider Demographics
NPI:1740371681
Name:GLOVER, DAVID B (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:GLOVER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 E RED ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:MORGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84050-9895
Mailing Address - Country:US
Mailing Address - Phone:801-829-3041
Mailing Address - Fax:
Practice Address - Street 1:6112 S 1550 E
Practice Address - Street 2:SUITE 201
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4859
Practice Address - Country:US
Practice Address - Phone:801-479-7505
Practice Address - Fax:801-475-1855
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370437-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT200302299OtherTAX ID
UTU72412Medicare UPIN
UT005750503Medicare ID - Type Unspecified