Provider Demographics
NPI:1831197185
Name:GLORE, MARTIN S (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:S
Last Name:GLORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5669
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-5669
Mailing Address - Country:US
Mailing Address - Phone:956-682-8588
Mailing Address - Fax:956-682-8233
Practice Address - Street 1:2719 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3433
Practice Address - Country:US
Practice Address - Phone:956-682-8588
Practice Address - Fax:956-682-8233
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9054174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0089CHOtherBCBS PROVIDER NUMBER
TXG14077Medicare UPIN
TX0089CHOtherBCBS PROVIDER NUMBER