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Contact Information

GLENN D MCCLENDON, DPM
2425 DAVE WARD DR STE 1
CONWAY, AR72034-8686
 Phone: 501-504-2737
 Fax: 501-499-9890
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Podiatrist

213E00000X 48 Podiatry
Indicates primary specialty

NPI Profile & details for GLENN D MCCLENDON · (Male)

NPI Number 1265425656
Status Active
Credentials DPM (Doctor of Podiatric Medicine)
Entity Individual
Enumeration date 08/31/2005
Last updated 10/07/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • AR License # 140
  • AR Medicaid 127342717
  • AR Other 5S956 BCBS
  • AR Other 15710000001 QUALCHOICE
  • AR Other P0025174 RR MEDICARE
Hospital affiliation(s)
  • CONWAY REGIONAL MEDICAL CENTER - (Acute Care)
    2302 COLLEGE AVENUE
    CONWAY, AR 72034
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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