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Contact Information

TIMOTHY C GLENNON II, PA
4140 CENTENNIAL HILLS BLVD
SUITE A
CASPER, WY82609
 Phone: 307-265-7205
 Fax: 307-235-6262
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for TIMOTHY C GLENNON II · (Male)

NPI Number 1447286943
Status Active
Credentials PA (Physician Assistant)
Entity Individual
Enumeration date 06/25/2006
Last updated 07/11/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • LA License # PA200064
  • WY License # TL556
  • LA Medicaid 1363839
Hospital affiliation(s)
  • WYOMING MEDICAL CENTER - (Acute Care)
    1233 EAST 2ND ST
    CASPER, WY 82601
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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