Individual
GLENN P. DEWBERRY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2701 N ROCKWELL AVE, BETHANY, OK 73008-5246
(405) 755-4050
(405) 752-1553
Mailing address
4401 W MEMORIAL RD, SUITE #140, OKLAHOMA CITY, OK 73134-1785
(405) 752-3162
(405) 936-5211
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11240
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080156332
RAILROAD
OK
05
—
100110540B
—
OK
01
—
11240
LICENSE
OK
01
—
15648
OBNDD
OK
Enumeration date
06/18/2006
Last updated
04/28/2014
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