Provider Demographics
NPI:1083898779
Name:ALEXANDRIA UROLOGY P.C.
Entity Type:Organization
Organization Name:ALEXANDRIA UROLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GLESNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-234-2649
Mailing Address - Street 1:112 PARK LANE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-1514
Mailing Address - Country:US
Mailing Address - Phone:319-234-2649
Mailing Address - Fax:319-233-2430
Practice Address - Street 1:112 PARK LANE
Practice Address - Street 2:ROOM 5
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701
Practice Address - Country:US
Practice Address - Phone:319-234-2649
Practice Address - Fax:319-233-2430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty