Individual
MR. GLENN LAURENCE LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
790 E 5TH ST, COQUILLE, OR 97423
(541) 396-3111
(541) 396-5891
Mailing address
790 E 5TH ST, COQUILLE, OR 97423
(541) 247-3000
(541) 247-3101
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD162422
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500662335
—
OR
01
—
93-0937095
CURRY HEALTH DISTRICT TAX IDN
OR
01
—
R00000ZGBDG
CURRY MEDICAL PRACTICE / CURRY MEDICAL CENTER MEDICARE PART B
OR
Enumeration date
07/18/2006
Last updated
12/21/2021
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