Provider Demographics
NPI:1265471049
Name:GLAZIER, FREDERICK M (PA)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:M
Last Name:GLAZIER
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:PO BOX 52890
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0145
Mailing Address - Country:US
Mailing Address - Phone:480-357-8411
Mailing Address - Fax:480-357-8532
Practice Address - Street 1:2080 W SOUTHERN AVE
Practice Address - Street 2:STE. A2
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-7455
Practice Address - Country:US
Practice Address - Phone:480-357-8411
Practice Address - Fax:480-357-8532
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-07-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT796ZMedicare PIN