Provider Demographics
NPI:1366479750
Name:GLASCOCK, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:GLASCOCK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:516 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2382
Practice Address - Country:US
Practice Address - Phone:319-268-3990
Practice Address - Fax:319-268-3995
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-13
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Provider Licenses
StateLicense IDTaxonomies
IA34063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1273144Medicaid
IA1273144Medicaid
IAH58395Medicare UPIN