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Individual

MR. GLENN KINGERY JR.

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
1853 OCONNELL ST, BLDG 1042, FORT CARSON, CO 80913
(719) 524-5290
Mailing address
7844 SCARBOROUGH DR, COLORADO SPRINGS, CO 80920-7107

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
575
CO

Other

Enumeration date
02/15/2006
Last updated
07/08/2007
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