Individual
GLENN R SLOCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
45137
AZ
2085R0202X
Diagnostic Radiology Physician
Primary
G74578
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G745780
BLUE SHIELD
CA
05
—
00G745780
—
CA
01
—
P00449079
RAILROAD MEDICARE
—
Enumeration date
05/11/2006
Last updated
04/22/2015
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