Active NPI
Andrew Mark Glenn, DO
- Aerospace Medicine Physician
- Fort Hood, TX
National Provider Identifier
1700378635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Aerospace Medicine Physician
- License
- 2091
- Practice address
- 36065 Santa Fe Ave
Fort Hood, TX 76544-5060 - Phone
- (254) 288-8000
- NPI assigned
- Jun 6, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Aerospace Medicine Physician | 2083A0100X | 2091 | NE | Primary |
| General Practice Physician | 208D00000X | 2091 | NE |
Addresses
Primary practice location
36065 Santa Fe Ave
Fort Hood, TX 76544-5060
Mailing address
209 Nolan Ridge Dr
Nolanville, TX 76559-4639
Phone (775) 219-5861
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2091 | NE | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1528243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741219200000",
"number": "1700378635",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 NOLAN RIDGE DR",
"city": "NOLANVILLE",
"state": "TX",
"postal_code": "765594639",
"telephone_number": "775-219-5861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36065 SANTA FE AVE",
"city": "FORT HOOD",
"state": "TX",
"postal_code": "765445060",
"telephone_number": "254-288-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLENN",
"first_name": "ANDREW",
"middle_name": "MARK",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-06",
"last_updated": "2025-03-06",
"certification_date": "2025-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "2083A0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Aerospace Medicine",
"state": "NE",
"license": "2091",
"primary": true
},
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "NE",
"license": "2091",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Hood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.