Individual
GLENN A JOCKLE
Active
Individual
GLENN A JOCKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
D0026956
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429581100
—
MD
01
—
KU59ST / 600433-01
BC / BS OF MD
MD
01
—
S185 / 0015
BLUECHOICE
MD
01
—
S797 / 600433-01
BC / BS OF MD
MD
Enumeration date
06/11/2006
Last updated
01/04/2016
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