Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | MD044262 | DC |
Y | 207N00000X | Dermatologist | ME57995 | FL |
N | 207ND0900X | Dermatopathologist | MD044262 | DC |
N | 207ND0900X | Dermatopathologist | ME57995 | FL |
NPI | 1699716787 |
---|---|
Provider Name | Lewis Frank Glass |
First Address | Washington, DC 20037-3201 |
Second Address | Washington, DC 20037-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
064273800 | (05) | FL |
11312 | BCBS (01) | FL |
E66868 | (02) | FL |