Individual
DR. JEFFREY E GLADD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1234 E DUPONT RD, SUITE 3, FORT WAYNE, IN 46825-1545
(260) 373-9965
(260) 458-5664
Mailing address
10515 ILLINOIS RD, FORT WAYNE, IN 46814-9182
(260) 373-9233
(260) 373-9219
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01056652
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000346257
ANTHEM
IN
01
—
000000570551
ANTHEM
IN
01
—
15705
PHP
IN
05
—
200488620A
—
IN
01
—
351972384039
TRICARE
IN
01
—
7059457
AETNA
IN
01
—
8194415
CIGNA
IN
01
—
P00334586
RAILROAD MEDICARE
IN
Enumeration date
08/02/2005
Last updated
09/22/2009
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