Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 6502 | NV |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 6502 | NV |
NPI | 1518059617 |
---|---|
Provider Name | Dr. Mark L Glyman |
First Address | Las Vegas, NV 89119-0818 |
Second Address | Las Vegas, NV 89119-0818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 23/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20-19211 | (05) | NV |
F39939 | (02) | NV |