Provider Demographics
NPI:1437526449
Name:GLAESER, SALLY (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:GLAESER
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 1:14813 NW 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2009
Mailing Address - Country:US
Mailing Address - Phone:352-332-1907
Mailing Address - Fax:
Practice Address - Street 1:14813 NW 41ST AVE
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-2009
Practice Address - Country:US
Practice Address - Phone:352-332-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA27816208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice