Basic Information
| Provider Information | |||||||||
| NPI: | 1467429050 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACPHERSON | ||||||||
| FirstName: | GLEN | ||||||||
| MiddleName: | DOUGLAS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7008 INDIANA AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794136114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8066988088 | ||||||||
| FaxNumber: | 8066988588 | ||||||||
| Practice Location | |||||||||
| Address1: | 2833 BABCOCK RD | ||||||||
| Address2: | STE 105 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295390 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107055030 | ||||||||
| FaxNumber: | 2107055035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 07/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083A0100X | 01056456A | IN | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 2083P0011X | M9470 | TX | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 2083P0901X | M9470 | TX | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine | 207P00000X | 4301106834 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.