Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | G13844 | CA |
NPI | 1063513737 |
---|---|
Provider Name | Glenn Donald Garbutt |
First Address | Fresno, CA 93720-3307 |
Second Address | Fresno, CA 93720-3307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 18/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G138440 | (05) | CA |
A39103 | (02) | CA |
G13844 | CALIFORNIA LICENSE (01) | CA |