Individual
GLENN RIEGO PUERTOLLANO
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
321C EAST COLLEGE AVE, RED RIVER HEALTH CARE, STANTON, KY 40380
(606) 663-9797
(606) 663-9470
Mailing address
PO BOX 2748, RED RIVER HEALTH CARE, PIKEVILLE, KY 41502-2748
(606) 432-3221
(606) 437-0438
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
38924
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64094683
—
KY
Enumeration date
01/30/2006
Last updated
07/08/2007
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