Provider Demographics
NPI:1437143427
Name:GLAZIER, ADAM JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JOHN
Last Name:GLAZIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 15TH ST S
Mailing Address - Street 2:UNIT C
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5978
Mailing Address - Country:US
Mailing Address - Phone:515-771-7143
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-239-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21981207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA02734Medicare UPIN