Provider Demographics
NPI:1407887979
Name:GLASER, JOSEPHINE LEE AGUHOB (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:LEE AGUHOB
Last Name:GLASER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-3405
Mailing Address - Country:US
Mailing Address - Phone:314-328-0144
Mailing Address - Fax:314-788-3021
Practice Address - Street 1:3721 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-3405
Practice Address - Country:US
Practice Address - Phone:314-328-0144
Practice Address - Fax:314-788-3021
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015005800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4000501OtherMEDICARE LAB GROUP
KYCB5773OtherRR MEDICARE GROUP
KY080150788OtherRR MEDICARE PIN NO
KY37903705OtherMEDICAID LAB GROUP
KY64341589Medicaid
KY0623803Medicare ID - Type Unspecified
G94921Medicare UPIN