Provider Demographics
NPI:1235220146
Name:GLACY, STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:GLACY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9787 N 91ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5088
Mailing Address - Country:US
Mailing Address - Phone:480-860-8300
Mailing Address - Fax:480-860-8398
Practice Address - Street 1:9787 N 91ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5088
Practice Address - Country:US
Practice Address - Phone:480-860-8300
Practice Address - Fax:480-860-8398
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17082208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0823700OtherBLUE CROSS BLUE SHIELD
AZE39062Medicare UPIN
AZAZ0823700OtherBLUE CROSS BLUE SHIELD