Provider Demographics
NPI:1043731771
Name:GLAZIER, DEREK (PA)
Entity Type:Individual
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First Name:DEREK
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Last Name:GLAZIER
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Gender:M
Credentials:PA
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Mailing Address - Street 1:5560 KIETZKE LN.
Mailing Address - Street 2:BLDG. A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-322-7811
Mailing Address - Fax:775-322-1431
Practice Address - Street 1:5560 KIETZKE LN.
Practice Address - Street 2:BLDG. A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-322-7811
Practice Address - Fax:775-322-1431
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2018-07-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant