Basic Information
| Provider Information | |||||||||
| NPI: | 1538201645 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLENN | ||||||||
| FirstName: | CHAR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 821350 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986820030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032749818 | ||||||||
| FaxNumber: | 5032480049 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 NW LOVEJOY ST STE 422 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972105102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032749818 | ||||||||
| FaxNumber: | 5032480049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD20114 | OR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.