Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 036059380 | IL |
N | 207ND0900X | Dermatopathologist | 036059380 | IL |
Y | 207NS0135X | Procedural Dermatology | 036059380 | IL |
NPI | 1770587206 |
---|---|
Provider Name | Scott David Glazer |
First Address | Buffalo Grove, IL 60089-2089 |
Second Address | Buffalo Grove, IL 60089-2089 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 05/01/2016 |