Provider Demographics
NPI:1508008889
Name:GLENN J SAUCER MD PA
Entity Type:Organization
Organization Name:GLENN J SAUCER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAUCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-264-2422
Mailing Address - Street 1:1722 PINE ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-1103
Mailing Address - Country:US
Mailing Address - Phone:334-264-2422
Mailing Address - Fax:334-264-9294
Practice Address - Street 1:1722 PINE ST
Practice Address - Street 2:SUITE 603
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-1103
Practice Address - Country:US
Practice Address - Phone:334-264-2422
Practice Address - Fax:334-264-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12568174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000015771Medicaid
ARC74988Medicare UPIN
AL000015771Medicaid