Individual
JON-MICHAEL GLEN CLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
Mailing address
3414 GOLDEN RD, TYLER, TX 75701-8336
(903) 939-7500
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
BP10044610
TX
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
P8872
TX
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
P8872
TX
Other
Enumeration date
06/21/2012
Last updated
10/22/2022
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