Individual
CARMON L GLOVER III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
211 S 3RD ST, BELLEVILLE, IL 62220-1915
(618) 234-2120
Mailing address
PO BOX 8882, FORT WORTH, TX 76124-0882
(817) 451-4208
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036098224
IL
208D00000X
General Practice Physician
036098224
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0008232056
BLUECROSS BLUESHIELD
IL
05
—
036098224
—
IL
01
—
06032182
BLUE CROSS BLUE SHIELD
IL
01
—
08232204
BLUE CROSS BLUE SHIELD
IL
01
—
08232205
BLUE CROSS BLUE SHIELD
IL
01
—
P00342997
RAILROAD MEDICARE
IL
Enumeration date
05/26/2006
Last updated
03/25/2013
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