Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | F6669 | TX |
Y | 2080P0214X | Pediatric Pulmonologist | F6669 | TX |
NPI | 1538387865 |
---|---|
Provider Name | Loren Matthew Glasser |
First Address | Dallas, TX 75235-7701 |
Second Address | Dallas, TX 75235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 11/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C16142 | (02) |