Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 67240-20 | WI |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 67240-20 | WI |
NPI | 1629365135 |
---|---|
Provider Name | Tiffany Ann Glazer |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-5312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 27/01/2021 |