Provider Demographics
NPI:1174685721
Name:GLASSHEIM, JEFFREY W (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:GLASSHEIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1010 LAS LOMAS RD NE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2634
Mailing Address - Country:US
Mailing Address - Phone:505-246-8700
Mailing Address - Fax:866-571-9011
Practice Address - Street 1:1010 LAS LOMAS RD NE
Practice Address - Street 2:SUITE 4
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2634
Practice Address - Country:US
Practice Address - Phone:505-246-8700
Practice Address - Fax:866-571-9011
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1656-122084A0401X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43522500Medicaid
NM76622339Medicaid
WI43522500Medicaid
WI001571483Medicare PIN
F67086Medicare UPIN