Individual
DR. GLENN A MCDONALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3535 N FOURTH ST STE 301, LONGVIEW, TX 75605-0037
(903) 234-9992
(903) 234-8287
Mailing address
3535 N FOURTH ST STE 301, LONGVIEW, TX 75605-0037
(903) 234-9992
(903) 234-8287
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
308302
LA
207RN0300X
Nephrology Physician
Primary
J0114
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
752896100
COMMERCIAL
TX
01
—
8B0772
BLUE CROSS & BLUE SHIELD
TX
Enumeration date
04/20/2006
Last updated
10/06/2021
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