Provider Demographics
NPI:1215199674
Name:DAVID I GLASSMAN DO PC
Entity Type:Organization
Organization Name:DAVID I GLASSMAN DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:GLASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-747-7026
Mailing Address - Street 1:4444 N 32ND ST
Mailing Address - Street 2:STE 220
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3956
Mailing Address - Country:US
Mailing Address - Phone:602-747-7026
Mailing Address - Fax:602-957-1997
Practice Address - Street 1:4444 N 32ND ST
Practice Address - Street 2:STE 220
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3956
Practice Address - Country:US
Practice Address - Phone:602-747-7026
Practice Address - Fax:602-957-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3988261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ110758OtherMEDICARE PTAN
AZZ151824OtherMEDICARE PTAN #2
AZ119117Medicaid
AZZ151824OtherMEDICARE PTAN #2
AZI59817Medicare UPIN