Provider Demographics
NPI:1356340848
Name:GLOVINSKY, EDMUND (DO)
Entity type:Individual
Prefix:
First Name:EDMUND
Middle Name:
Last Name:GLOVINSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-9674
Mailing Address - Country:US
Mailing Address - Phone:541-582-0505
Mailing Address - Fax:541-582-0778
Practice Address - Street 1:509 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-9674
Practice Address - Country:US
Practice Address - Phone:541-582-0505
Practice Address - Fax:541-582-0778
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO12393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000WCGTMBMedicare ID - Type Unspecified
OR262808Medicare ID - Type Unspecified
ORE20612Medicare UPIN