Provider Demographics
NPI:1114968567
Name:GLASS, JAMES M (MD , PH D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD , PH D
Other - Prefix:
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Mailing Address - Street 1:1925 MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3128
Mailing Address - Country:US
Mailing Address - Phone:720-494-3117
Mailing Address - Fax:303-485-3348
Practice Address - Street 1:1925 MOUNTAIN VIEW AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3128
Practice Address - Country:US
Practice Address - Phone:720-494-3117
Practice Address - Fax:303-485-3348
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-01-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0033444207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01334440Medicaid
COCC9244Medicare PIN
CO01334440Medicaid
COE80857Medicare UPIN
COC155968Medicare PIN