Provider Demographics
NPI:1932239100
Name:KREMER, GLENDA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:MARIE
Last Name:KREMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:GLENDA
Other - Middle Name:MARIE
Other - Last Name:AMISIAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3514
Mailing Address - Country:US
Mailing Address - Phone:817-334-1400
Mailing Address - Fax:817-334-1410
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3514
Practice Address - Country:US
Practice Address - Phone:817-334-1400
Practice Address - Fax:817-334-1410
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX197396805Medicaid
TX197396804Medicaid
TX197396806OtherMEDICAID OTHER
TX197396807Medicaid
TX197396805Medicaid
TX197396807Medicaid