Individual
MR. GLENN ZEIDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1126 COUNTRY CLUB RD, MCCOMB, MS 39648-5952
(601) 250-0139
(601) 250-0139
Mailing address
1126 COUNTRY CLUB RD, MCCOMB, MS 39648-5952
(601) 250-0139
(601) 250-0139
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18759
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00433021
—
MS
Enumeration date
05/05/2006
Last updated
07/23/2012
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