Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 2021023179 | MO |
N | 207NS0135X | Procedural Dermatology | 2021023179 | MO |
NPI | 1497100713 |
---|---|
Provider Name | Katherine Glaser |
First Address | Clayton, MO 63105-3530 |
Second Address | Hannibal, MO 63401-6884 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2016 |
Last Update Date | 12/02/2022 |