Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 248 | AL |
NPI | 1104821222 |
---|---|
Provider Name | Dr. Glenn Stephen Mcphillips |
First Address | Selma, AL 36701-6506 |
Second Address | Selma, AL 36701-6506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2005 |
Last Update Date | 26/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MC051552783 | (05) | AL |
U84882 | (02) |