Provider Demographics
NPI:1821223140
Name:GLOVER, KATHRYN BAKSH (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:BAKSH
Last Name:GLOVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:BAKSH
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-263-2619
Mailing Address - Fax:970-263-2691
Practice Address - Street 1:688 23 1/2 RD STE 201
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-8904
Practice Address - Country:US
Practice Address - Phone:970-254-3180
Practice Address - Fax:970-254-3198
Is Sole Proprietor?:No
Enumeration Date:2009-05-17
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.0072141207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program