Individual
GLENN IVAN BASCON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
DWIGHT DAVID EISENHOWER ARMY MEDICAL CENTER, 300 EAST HOSPITAL ROAD, FORT EISENHOWER, GA 30905-5650
(706) 787-9399
Mailing address
300 EAST HOSPITAL ROAD, FORT EISENHOWER, GA 30905
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
17475
GA
Other
Enumeration date
05/12/2025
Last updated
07/10/2025
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