Provider Demographics
NPI:1437486016
Name:GLASS, LEONARD WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:WALTER
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 423
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-0423
Mailing Address - Country:US
Mailing Address - Phone:858-692-3875
Mailing Address - Fax:858-756-0610
Practice Address - Street 1:4510 EXECUTIVE DR
Practice Address - Street 2:105
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3021
Practice Address - Country:US
Practice Address - Phone:859-692-3875
Practice Address - Fax:858-756-0610
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2024-04-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC29929208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery