Provider Demographics
NPI:1306230586
Name:GLASGOW, PHILLIP JAY II (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:JAY
Last Name:GLASGOW
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:34 SUGAR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-9285
Mailing Address - Country:US
Mailing Address - Phone:870-451-3211
Mailing Address - Fax:870-779-6093
Practice Address - Street 1:300 E 6TH ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-5207
Practice Address - Country:US
Practice Address - Phone:870-779-6000
Practice Address - Fax:870-779-6093
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2019-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-10375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine