Provider Demographics
NPI:1881692382
Name:GLUCK, BRION A (MD)
Entity type:Individual
Prefix:DR
First Name:BRION
Middle Name:A
Last Name:GLUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 N MESA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3554
Mailing Address - Country:US
Mailing Address - Phone:915-577-9900
Mailing Address - Fax:915-577-0200
Practice Address - Street 1:1800 N MESA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3553
Practice Address - Country:US
Practice Address - Phone:915-577-9900
Practice Address - Fax:915-577-0200
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9954207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115581402Medicaid
TXF85018Medicare UPIN
TX88215J0Medicare ID - Type Unspecified