Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | G30174 | CA |
NPI | 1063583037 |
---|---|
Provider Name | Sidney M. Glazer |
First Address | Anaheim, CA 92807-3028 |
Second Address | Anaheim, CA 92807-3028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 01/12/2021 |