Glenn Donnelly, D.O., MPH

Primary specialty

Aerospace Medicine PhysicianTaxonomy code 2083A0100X

License

L6867 Issued in TX

Practice address

1381 S Patrick Dr
Patrick AFB, FL 32925-3606

Phone

(318) 828-3856

NPI assigned

Jan 19, 2006

Last updated

Nov 15, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Concord Radiology PLLC

  • Diagnostic Radiology Physician
  • Lubbock, TX
  • NPI 1598260515
  NPD (past)
• East San Antonio Images Inc

  • Diagnostic Radiology Physician
  • Austin, TX
  • NPI 1801193933
  NPD (past)
• Southwest Medical Associates, Inc.

  • Emergency Medicine Physician
  • Electra, TX
  • NPI 1831299122
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352937600000",
    "number": "1730169400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1381 S PATRICK DR",
            "city": "PATRICK AFB",
            "state": "FL",
            "postal_code": "329253606",
            "telephone_number": "318-828-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1381 S PATRICK DR",
            "city": "PATRICK AFB",
            "state": "FL",
            "postal_code": "329253606",
            "telephone_number": "318-828-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "D.O., MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2012-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "TX",
            "license": "L6867",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin S Davis, FNP-BC
• Efrain A Delvalle, PHARMACIST
• Daniel Stephen Demick, MD
• Minal S Desai, MD
• Emanuel Diaz, MD
• Paul Drylewski, R.PH.
• Randy W Dutton, OPTOMETRIST
• Jose F Eduardo, DMD
• Jade Esmailzadeh, R.D., LDN
• David M Farrell, PT

• Aerospace Medicine Physician in Patrick AFB, FL
• Providers in Patrick AFB, FL by specialty
• Aerospace Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.