Individual
GLEN ROY DAUGHTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2850 COMMERCE DR STE 300, HARRISBURG, PA 17110-9383
(717) 657-1361
(717) 657-5396
Mailing address
7 DOCK HILL RD, MIDDLEBURG, PA 17842-8910
(570) 837-2123
(570) 837-2185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS006776E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0014956000003
—
PA
Enumeration date
08/25/2005
Last updated
04/14/2022
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