Individual
GLENN ERIC GIFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
333 LAWS AVE, UKIAH, CA 95482-6540
(707) 468-1010
(707) 462-7532
Mailing address
333 LAWS AVE, UKIAH, CA 95482-6540
(707) 468-1010
(707) 462-7532
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
61224
CA
363A00000X
Physician Assistant
MA053012
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13654471
CAQH
—
Enumeration date
01/07/2008
Last updated
04/21/2026
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