Individual
MR. GLEN EDWARD COMBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2255 LEWISVILLE CLEMMONS RD, CLEMMONS, NC 27012-7463
(336) 766-0505
Mailing address
512 BURKEWOOD DR, WINSTON SALEM, NC 27104-3945
(336) 970-3800
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
101309
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-010
CHAMPUS/TRICARE
VA
05
—
009241E25
—
VA
01
—
101309
MEDICAL BOARD LICENSE
NC
Enumeration date
02/09/2006
Last updated
03/07/2023
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