Individual
MARK W GLOVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
01548
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183800719
—
AR
05
—
1972590537
—
MO
05
—
200286220A
—
OK
05
—
493583108
—
MO
05
—
493583124
—
MO
01
—
680007342
RR MEDICARE
MO
01
—
P00251264
RR MEDICARE
—
01
—
P00894315
RR MEDICARE
AR
Enumeration date
09/29/2005
Last updated
09/11/2015
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