Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | A358189 | CA |
Y | 207Q00000X | Family Doctor | A35818 | CA |
NPI | 1447300504 |
---|---|
Provider Name | Robert A Glazer |
First Address | Los Angeles, CA 90029-1252 |
Second Address | Los Angeles, CA 90029-1252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 02/02/2010 |