Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 7790 | AZ |
NPI | 1134753908 |
---|---|
Provider Name | Robert Glenn |
First Address | Phoenix, AZ 85060-0217 |
Second Address | Scottsdale, AZ 85258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2020 |
Last Update Date | 23/09/2021 |