Provost, Glenn
Provost, Glenn is an sole proprietor health care provider with primary practice located at 17100 Euclid St , Fountain Valley CA 92708-4004. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Provost, Glenn can be contacted via phone (714) 979-1211.Contact Information
Primary practice address
17100 Euclid St
Fountain Valley CA 92708-4004
Phone: (714) 979-1211
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | G79498 | California |
Profile Details
| NPI number | 1326003229 |
|---|---|
| LBN Legal business name | Provost, Glenn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 20th, 2006 |
| Last updated | Apr 11th, 2016 - about 8 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1326003229 | NPPES |
| California | MEDICAID | 00G794980 |
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