Krista, Mathew Glen

Krista, Mathew Glen is an individual health care provider with primary practice located at 4126 West Main Street , Dothan AL 36305-9310. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Krista, Mathew Glen can be contacted via phone (334) 793-2120.

Contact Information

Primary practice address
4126 West Main Street Dothan AL 36305-9310
Phone: (334) 793-2120
Fax: (334) 671-0228
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 32247 Kentucky
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 21833 Alabama

Profile Details

NPI number 1093779738
LBN Legal business name Krista, Mathew Glen
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 12th, 2006
Last updated Sep 23rd, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093779738 NPPES
Georgia MEDICAID 000799664B
Georgia MEDICAID 1756539
Georgia Other 51515842
Georgia MEDICAID 06009894
Georgia Other P00055578
Georgia MEDICAID 051515842
Georgia MEDICAID 255415100

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