Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | ME56612 | FL |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | N9706 | TX |
N | 2081S0010X | Sports Medicine | ME56612 | FL |
N | 213ES0000X | Sports Medicine | ME56612 | FL |
NPI | 1427058205 |
---|---|
Provider Name | Dr. P Mark Glencross |
First Address | Houston, TX 77057-5641 |
Second Address | Houston, TX 77030-2717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 04/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F01256 | (02) |