Individual
DR. TRISTAN DAVID GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1919 LATHROP ST, FAIRBANKS, AK 99701-5937
(907) 459-2619
(907) 374-1089
Mailing address
PO BOX 73720, FAIRBANKS, AK 99707-3720
(207) 838-2090
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
Primary
234573
AK
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
234573
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1755983
—
AK
Enumeration date
07/01/2022
Last updated
07/29/2025
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