Provider Demographics
NPI:1285631721
Name:COLGLAZIER, CLIFFORD RAY (MD)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:RAY
Last Name:COLGLAZIER
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 1:912 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-3099
Mailing Address - Country:US
Mailing Address - Phone:308-352-7100
Mailing Address - Fax:
Practice Address - Street 1:912 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:NE
Practice Address - Zip Code:69140-3099
Practice Address - Country:US
Practice Address - Phone:308-352-7100
Practice Address - Fax:308-352-7103
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE14390208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENE14390Medicaid
NE02717OtherBLUE CROSS
NEB67742Medicare UPIN
NENE14390Medicaid