DR. GLENN DAVID MCDERMOTT (NPI# 1255309449) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255309449 |
| Entity Type | Individual |
| Full Name | DR. GLENN DAVID MCDERMOTT |
| Credential | M.D. |
| Practice Address |
Madigan Army Medical Center 9040 Reid St; Attn: Mchj-qcr Tacoma WA 98431-0001 |
| Practice Telephone | 2539682252 |
| Practice Fax Number | 2539683278 |
| Mailing Telephone | 2539682252 |
| Mailing Fax Number | 2539683278 |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2083A0100X |
Preventive Medicine Specialization: Aerospace Medicine |
182618-1205 | UT | Allopathic & Osteopathic Physicians |
| X | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
182618-1205 | UT | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447261862 | Glenn R Mcdermott | Family Medicine | 1368 N Great Neck Road, Virginia Beach, VA 23454 | 2006-08-10 |
| Street Address |
MADIGAN ARMY MEDICAL CENTER 9040 REID ST; ATTN: MCHJ-QCR |
| City | TACOMA |
| State | WA |
| Zip Code | 98431-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770577322 | Bernice Joann Wilder | Registered Nurse | Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98438-1336 | 2005-09-09 |
| 1013569466 | Bradley Eugene Foster | Licensed Practical Nurse | Madigan Army Medical Center, 9040 Jackson Ave, Attn: Mcln-clq-c, Tacoma, WA 98431-1100 | 2019-07-15 |
| 1245702794 | Theresa Lynn Abrahamson | Registered Nurse | Madigan Army Medical Center, 9040 Jackson Ave, Attn: Mchj-clq-c, Tacoma, WA 98431-1100 | 2018-12-21 |
| 1437629953 | Laura Peratino | Registered Nurse | Madigan Army Medical Center, 9040 Jackson Ave, Attn: Mchj-clq-c, Tacoma, WA 98431-1100 | 2018-11-27 |
| 1568937837 | Gregory Gogue Tainatongo | Emergency Medical Technician, Basic | Madigan Army Medical Center, 9040 Jackson Ave, Attn: Mchj-clq-c, Tacoma, WA 98431-1100 | 2018-10-12 |
| 1689157935 | Barbara Hewitt | Registered Nurse | Madigan Army Medical Center, 9040 Jackson Ave, Attn: Mchj-clq-c, Tacoma, WA 98431-1100 | 2018-09-12 |
| 1508350539 | Keaton Allyn Johnson | Physician Assistant | Madigan Army Medical Center, Tacoma, WA 98431-5318 | 2018-06-22 |
| 1073006235 | Jonathan Daniel Clemons | Physician Assistant | Madigan Army Medical Center, 9040 Jackson Ave, Tacoma, WA 98431-1100 | 2018-06-12 |
| 1457841397 | Tiffany Lefebre | Emergency Medical Technician, Basic | Madigan Army Medical Center, 9040 Jackson Ave, Attn: Mchj-clq-c, Tacoma, WA 98431-1100 | 2018-05-16 |
| 1619473683 | Kristin Michelle Lacer | Registered Nurse | Madigan Army Medical Center, 9040 Jackson Ave Attn: Mchj-clq-c, Tacoma, WA 98431 | 2018-03-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497212260 | Catrina Renee Grugin | Registered Nurse | Madigan Army Medical Center, Attn Mchj-clq-c, 9040 Jackson Ave, Tacoma, WA 98431 | 2019-02-27 |
| 1801307681 | Bianca Gomez | Dental Assistant | Bldg 9900 Lincoln Street, Jblm, WA 98431 | 2017-10-19 |
| 1184133225 | Darren Paris | Registered Nurse | Madigan Army Medical Center 9040 Jackson Ave., Attn: Mchj-clq-c, Tacoma, WA 98431 | 2017-09-20 |
| 1922538206 | Sarah Frerichs | Dentist | Madigan Annex, Second Floor, Bldg. 9900, Apo, AA 98431 | 2017-06-19 |
| 1740736495 | Misty Hill | Dental Assistant | 9119 Mill Park Ave, Tacoma, WA 98431 | 2016-08-31 |
| 1336695535 | Jacqueline D Massouda | Dentist | Jblm Dentac, 9900 Lincoln Sreet, 2nd Floor, Apo, AA 98431 | 2016-08-28 |
| 1609239375 | Gregg V Palmer | Licensed Practical Nurse | 17th and C Street, Bldg 11582, Tacoma, WA 98431 | 2016-03-31 |
| 1114323904 | Deanna Sheets | Nurse Practitioner | 911 Mil Park Ave, Tacoma, WA 98431 | 2014-11-06 |
| 1679905434 | Austin William Schaar | Dentist | Building 9900, 2nd Floor, Tacoma, WA 98431 | 2013-08-05 |
| 1518209758 | Maurice Ibrahim Khayat | Internal Medicine | 9040 Jackson Ave Mche-qd (creds), Tacoma, WA 98431 | 2013-03-26 |
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| Taxonomy Code | 2083A0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Preventive Medicine |
| Specialization | Aerospace Medicine |
| Aerospace medicine focuses on the clinical care, research, and operational support of the health, safety, and performance of crewmembers and passengers of air and space vehicles, together with the support personnel who assist operation of such vehicles. This population often works and lives in remote, isolated, extreme, or enclosed environments under conditions of physical and psychological stress. Practitioners strive for an optimal human-machine match in occupational settings rich with environmental hazards and engineering countermeasures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Preventive Medicine, 2007. http://www.abprevmed.org/. American Osteopathic Board of Preventive Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Preventive Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Preventive Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174609341 | James Glazebrook Billingsley | Preventive Medicine | 1901 S Union, Tacoma, WA 98405 | 2006-10-31 |
| 1639115892 | Harry Quigg Davis IIi | Preventive Medicine | Madiagn Army Medical Center, Mchj-fp (avn Med), Tacoma, WA 98431-0001 | 2006-06-22 |
| 1851356133 | Paul J Amoroso | Preventive Medicine | Credententials Office Madigan Army Medical Ctr, 9040 Fitzsimons Drive, Attn: Mchj-ci, Tacoma, WA 98431-0001 | 2006-04-19 |
| 1639464464 | Jacob W Robinson | Preventive Medicine | Madigan Army Medical Center 9040 Jackson Ave, Tacoma, WA 98431-1089 | 2011-06-09 |
| 1871571232 | Breck Jon Lebegue | Preventive Medicine | 1717 S J St, Tacoma, WA 98405-4933 | 2006-01-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538431721 | William Michael Waring | Preventive Medicine | 4127 Sw Kenyon St, Seattle, WA 98136-2332 | 2012-02-02 |
| 1033442298 | Gary Lee Henriksen | Preventive Medicine | 362 Greywolf Rd, Sequim, WA 98382-7574 | 2009-09-04 |
| 1861582140 | Murl Edwin Leibrecht | Preventive Medicine | 578 Michael Way, Camano Island, WA 98282-8464 | 2006-10-15 |
| 1447343967 | Timothy J Ungs | Preventive Medicine | 6626 Chapel Hill Blvd Apt L104, Pasco, WA 99301-3880 | 2006-10-02 |
| 1588638787 | Richard John Montminy | Preventive Medicine | 4320 196th St Sw Ste D, Us Healthworks Medical Group, Lynnwood, WA 98036-6753 | 2006-02-14 |
| 1447230123 | Nicholas Antony Davenport | Preventive Medicine | 1465 Scurlock Ln, Mukilteo, WA 98275-1734 | 2006-01-19 |
| 1477539989 | Jamin T Mcmahon | Preventive Medicine | 7811 Reliance Ridge Ln, Gig Harbor, WA 98335-1196 | 2005-12-16 |
| 1619961505 | Robert Joshua Grant | Preventive Medicine | 601 Hospital Loop, Fairchild Afb, WA 99011 | 2005-09-07 |
| 1376535856 | Thomas Michael Slyter | Preventive Medicine | 6414 E Leola Ln, Port Orchard, WA 98366-8226 | 2005-08-19 |
| 1922488360 | Alexander Dominic Jobrack | Preventive Medicine | 690 Barnes Blvd, Joint Base Lewis Mcchord, WA 98438-1336 | 2015-06-01 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.