Provider Demographics
NPI:1558365577
Name:RICHARD G GLOGAU M D INC
Entity Type:Organization
Organization Name:RICHARD G GLOGAU M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:GLOGAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-564-1261
Mailing Address - Street 1:350 PARNASSUS AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3608
Mailing Address - Country:US
Mailing Address - Phone:415-564-1261
Mailing Address - Fax:415-564-1967
Practice Address - Street 1:350 PARNASSUS AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-3608
Practice Address - Country:US
Practice Address - Phone:415-564-1261
Practice Address - Fax:415-564-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-08
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28282207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25934ZMedicare PIN
CAA43678Medicare UPIN