Provider Demographics
NPI:1508823469
Name:GLASSMAN, JEREL H (DO)
Entity Type:Individual
Prefix:
First Name:JEREL
Middle Name:H
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 SHRADER STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117
Mailing Address - Country:US
Mailing Address - Phone:415-503-7456
Mailing Address - Fax:415-358-8112
Practice Address - Street 1:1 SHRADER STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117
Practice Address - Country:US
Practice Address - Phone:415-503-7456
Practice Address - Fax:415-358-8112
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A58772081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX58770Medicaid
020A58770Medicare ID - Type Unspecified
CAC89298Medicare UPIN