Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | A-1656-12 | NM |
NPI | 1174685721 |
---|---|
Provider Name | Dr. Jeffrey W Glassheim |
First Address | Albuquerque, NM 87102-2634 |
Second Address | Albuquerque, NM 87102-2634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 13/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
43522500 | (05) | WI |
76622339 | (05) | NM |
F67086 | (02) |