Individual
GLENN THOMAS AULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1450 SAN PABLO ST STE 6200, LOS ANGELES, CA 90033
(323) 865-3690
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 865-3690
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
A54651
CA
Other
Enumeration date
07/28/2006
Last updated
11/27/2023
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