Provider Demographics
NPI:1114397437
Name:GLASS, ANDREW CHRISTOPHER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:CHRISTOPHER
Last Name:GLASS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 NORTH GRAND AVE.
Mailing Address - Street 2:SUITE 508
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2757
Mailing Address - Country:US
Mailing Address - Phone:719-595-7040
Mailing Address - Fax:719-595-7045
Practice Address - Street 1:1600 NORTH GRAND AVE.
Practice Address - Street 2:SUITE 508
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2757
Practice Address - Country:US
Practice Address - Phone:719-595-7040
Practice Address - Fax:719-595-7045
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004402363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical