Provider Demographics
NPI:1912900283
Name:ESSES, GLENN E (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:E
Last Name:ESSES
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 1:1151 DAUPHIN ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2547
Mailing Address - Country:US
Mailing Address - Phone:251-445-0075
Mailing Address - Fax:251-445-0072
Practice Address - Street 1:1151 DAUPHIN ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2547
Practice Address - Country:US
Practice Address - Phone:251-445-0075
Practice Address - Fax:251-445-0072
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000191752086S0129X
ALMD191752086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000030017Medicaid
AL000030017Medicare PIN
AL30017Medicare ID - Type UnspecifiedVASCULAR SURGERY
ALG06876Medicare UPIN