Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 782 | NM |
NPI | 1760569990 |
---|---|
Provider Name | Dr. Robin Irvin Glass |
First Address | Bloomfield, NM 87413-5620 |
Second Address | Bloomfield, NM 87413-5305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |