Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A6532 | CA |
N | 207Q00000X | Family Doctor | 20A6532 | CA |
NPI | 1376674341 |
---|---|
Provider Name | Dr. John Charles Glover |
First Address | Vallejo, CA 94592 |
Second Address | Vallejo, CA 94590-5700 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 03/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E96528 | (02) | OH |