Individual
DR. SHAWN D GLISSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
676 S FLOYD ST FL 2, LOUISVILLE, KY 40202-1840
(502) 629-2500
(502) 629-2055
Mailing address
315 E BROADWAY, LOUISVILLE, KY 40202-3700
(502) 629-2500
(502) 629-2055
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
01042659A
IN
207RH0003X
Hematology & Oncology Physician
Primary
29701
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000051749
ANTHEM
KY
01
—
1068275
PASSPORT
KY
05
—
200034300A
—
IN
05
—
64297013
—
KY
01
—
830005455
RAILROAD MEDICARE
—
Enumeration date
02/08/2006
Last updated
11/10/2021
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