Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 14220 | SC |
Y | 2086S0120X | Pediatric Surgery | 33460 | AL |
NPI | 1568432250 |
---|---|
Provider Name | Dr. James G Glasser |
First Address | Mobile, AL 36640-0480 |
Second Address | Mobile, AL 36604-3304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 08/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D74121 | (02) | SC |
TL3641 | (05) | SC |