Provider Demographics
NPI:1336139773
Name:GLAUSER, TODD A (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:GLAUSER
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500541
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-0541
Mailing Address - Country:US
Mailing Address - Phone:520-256-0892
Mailing Address - Fax:
Practice Address - Street 1:6200 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3529
Practice Address - Country:US
Practice Address - Phone:520-297-7826
Practice Address - Fax:520-544-0060
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080983207ZP0102X
AZ31710207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ906399Medicaid
AZA20765770OtherBLUE CROSS BLUE SHIELD
AZ906399Medicaid
H59579Medicare UPIN