Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | F3141 | TX |
NPI | 1013962661 |
---|---|
Provider Name | Geoffrey Glynn Glidden |
First Address | Plano, TX 75024 |
Second Address | Plano, TX 75024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 20/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B23009 | (02) |