Individual
DR. GLEN A. PU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
950 COUNTY ROAD 553, BROWNWOOD, TX 76801-0345
(803) 381-7497
Mailing address
950 COUNTY ROAD 553, BROWNWOOD, TX 76801-0345
(803) 381-7497
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
042921
GA
2085R0202X
Diagnostic Radiology Physician
DR.0074111
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000728351Q
—
GA
01
—
52614708 012
BCBS
GA
01
—
8BJ664
BCBS
TX
05
—
9000236416
—
CO
Enumeration date
11/07/2005
Last updated
03/25/2025
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