Provider Demographics
NPI:1508083130
Name:WESLEY S. GLAZENER, MD, PA
Entity Type:Organization
Organization Name:WESLEY S. GLAZENER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:STANTON
Authorized Official - Last Name:GLAZENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-454-8691
Mailing Address - Street 1:1305 W 34TH ST
Mailing Address - Street 2:#206
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1923
Mailing Address - Country:US
Mailing Address - Phone:512-454-8691
Mailing Address - Fax:512-454-4238
Practice Address - Street 1:1305 W 34TH ST
Practice Address - Street 2:#206
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1923
Practice Address - Country:US
Practice Address - Phone:512-454-8691
Practice Address - Fax:512-454-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7305208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH7305OtherSTATE LICENSE
TXH7305OtherSTATE LICENSE