Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0223007 | MN |
NPI | 1013063452 |
---|---|
Provider Name | Ronald Joel Glasser |
First Address | Minneapolis, MN 55404 |
Second Address | Minneapolis, MN 55404-4526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05517GL | BLUE CROSS BLUE SHIELD (01) | MN |
3111348 | MEDICA (01) | MN |
A96100 | (02) | MN |