Individual
DR. GLEN R. LIESEGANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1345 HIGHWAY 268, PATTERSON, NC 28661
(828) 754-6850
(828) 758-3214
Mailing address
PO BOX 319, PATTERSON, NC 28661-0319
(828) 754-6850
(828) 758-3214
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31569
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51919
BCBS
NC
05
—
8951919
—
NC
Enumeration date
03/31/2006
Last updated
06/18/2012
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