Organization
JAMES J. GLYNN, M.D. A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MIMI J NEWCOMER (OFFICE MANAGER)
(707) 778-1131
Entity
Organization
Contact information
Practice address
1496 PROFESSIONAL DR, SUITE 601, PETALUMA, CA 94954-6698
(707) 778-1131
(707) 778-3818
Mailing address
1496 PROFESSIONAL DR, SUITE 601, PETALUMA, CA 94954-6698
(707) 778-1131
(707) 778-3818
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G22422
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1770768657
NPI
CA
01
—
DL686A
PTAN
CA
Enumeration date
01/09/2008
Last updated
11/27/2012
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