Provider Demographics
NPI:1376542563
Name:GLAZAR MEDICAL PA
Entity Type:Organization
Organization Name:GLAZAR MEDICAL PA
Other - Org Name:ADVANCED FOOT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:915-593-3668
Mailing Address - Street 1:1635 N LEE TREVINO DR
Mailing Address - Street 2:STE C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5175
Mailing Address - Country:US
Mailing Address - Phone:915-593-3668
Mailing Address - Fax:915-593-5010
Practice Address - Street 1:1635 N LEE TREVINO DR
Practice Address - Street 2:STE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5175
Practice Address - Country:US
Practice Address - Phone:915-593-3668
Practice Address - Fax:915-593-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1228213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0091MDOtherBC/BS
U23567Medicare UPIN
TX5298940001Medicare NSC
TX00304YMedicare PIN