Individual
DANIEL JOHN GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
201 ABRAHAM FLEXNER WAY STE 100, LOUISVILLE, KY 40202-3841
(502) 587-8222
(502) 587-0860
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0328
(502) 587-4784
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2687
KY
363A00000X
Physician Assistant
TC985
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300045010
—
IN
05
—
7100707330
—
KY
Enumeration date
04/07/2020
Last updated
01/04/2021
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