Individual
GLENN EDWARD HEIMBURGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1615 DELAWARE ST, LONGVIEW, WA 98632-2367
(360) 414-2000
Mailing address
PO BOX 751069, CHARLOTTE, NC 28275-1069
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2012-01680
NC
207P00000X
Emergency Medicine Physician
Primary
MD60466685
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171T4
BCBS NC
NC
05
—
1750500347
—
NC
Enumeration date
06/04/2010
Last updated
04/22/2023
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