Provider Demographics
NPI:1568506145
Name:GLASS, ALAN IRWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:IRWIN
Last Name:GLASS
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 1:1 BROOKINGS DR
Mailing Address - Street 2:CAMPUS BOX 1201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4862
Mailing Address - Country:US
Mailing Address - Phone:314-935-9626
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKINGS DR
Practice Address - Street 2:CAMPUS BOX 1201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4862
Practice Address - Country:US
Practice Address - Phone:314-935-9626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004000456390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program