Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 35085092 | OH |
N | 207XS0106X | Orthopaedic Hand Surgeon | 35085092 | OH |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 35085092 | OH |
NPI | 1275528275 |
---|---|
Provider Name | Dr. Merrill Lee Gladden JR. |
First Address | Bowling Green, OH 43402-2694 |
Second Address | Bowling Green, OH 43402-2694 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 25/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000350668 | ANTHEM (01) | OH |
04665 | PARAMOUNT (01) | OH |
2505041 | UNITED HEALTHCARE (01) | OH |
2517637 | (05) | OH |
3678364 | AETNA HMO (01) | OH |
7073656 | AETNA (01) | OH |
I23791 | (02) | OH |