Basic Information
| Provider Information | |||||||||
| NPI: | 1841280633 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHEXNAYDER | ||||||||
| FirstName: | GLENN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 214 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | DONALDSONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703464309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655500 | ||||||||
| FaxNumber: | 2254734406 | ||||||||
| Practice Location | |||||||||
| Address1: | 214 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | DONALDSONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703464309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257655500 | ||||||||
| FaxNumber: | 2254734406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 013272 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1181552 | 05 | LA | MEDICAID |