Basic Information
| Provider Information | |||||||||
| NPI: | 1619046661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUSER | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2069 | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599172069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062973145 | ||||||||
| FaxNumber: | 4062973364 | ||||||||
| Practice Location | |||||||||
| Address1: | 450 OSLOSKI RD | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599179534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062973145 | ||||||||
| FaxNumber: | 4062973364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 146N00000X | 0024793 | WA | X | Emergency Medical Service Providers | Emergency Medical Technician, Basic | 207Q00000X | 11439 | MT | X | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1619046661 | 01 | NPI | OTHER |