1629101662 NPI number — MR. JAMES E GLINN SR. PT

Table of content: MR. JAMES E GLINN SR. PT (NPI 1629101662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629101662 NPI number — MR. JAMES E GLINN SR. PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLINN
Provider First Name:
JAMES
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
SR.
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629101662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1106 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SAN LUIS OBISPO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93401-2416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-788-0805
Provider Business Mailing Address Fax Number:
805-788-0845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8200 STOCKDALE HWY
Provider Second Line Business Practice Location Address:
B1
Provider Business Practice Location Address City Name:
BAKERSFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93311-1091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-827-8959
Provider Business Practice Location Address Fax Number:
661-827-1779
Provider Enumeration Date:
03/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT1198 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)