Provider Demographics
NPI:1619929726
Name:DENNIS N GLASCOCK, DO LLC
Entity Type:Organization
Organization Name:DENNIS N GLASCOCK, DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:GLASCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:636-916-5551
Mailing Address - Street 1:530 VANCE RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY PARK
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1527
Mailing Address - Country:US
Mailing Address - Phone:636-225-5445
Mailing Address - Fax:
Practice Address - Street 1:330 1ST CAPITOL DR
Practice Address - Street 2:STE 270
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2835
Practice Address - Country:US
Practice Address - Phone:636-916-5551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty