Provider Demographics
NPI:1831252287
Name:GARY R GLYNN MD APMC
Entity type:Organization
Organization Name:GARY R GLYNN MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-897-8543
Mailing Address - Street 1:1401 FOUCHER STREET
Mailing Address - Street 2:SUITE M1005
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115
Mailing Address - Country:US
Mailing Address - Phone:504-897-8543
Mailing Address - Fax:504-897-8726
Practice Address - Street 1:1401 FOUCHER STREET
Practice Address - Street 2:SUITE M1005
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115
Practice Address - Country:US
Practice Address - Phone:504-897-8543
Practice Address - Fax:504-897-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1301680Medicaid
LA1688657Medicaid
LA1925594Medicaid
LA2106309Medicaid
LA2146645Medicaid
LA2146645Medicaid
LA1688657Medicaid
E31855Medicare UPIN
LA2106309Medicaid
LA52784Medicare PIN
B64131Medicare UPIN
LA1301680Medicaid
LA419531Medicare PIN
LA1301680Medicaid
LA5L452Medicare PIN