Provider Demographics
NPI:1689684805
Name:GLAZE, ARTHUR LAMAR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:LAMAR
Last Name:GLAZE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 JAMESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2335
Mailing Address - Country:US
Mailing Address - Phone:601-261-0455
Mailing Address - Fax:
Practice Address - Street 1:3800 JAMESTOWN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2335
Practice Address - Country:US
Practice Address - Phone:601-261-0455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00010502Medicaid
MS1558943OtherAMERICAN ADMIN GROUP
MS1432799OtherUNITED HEALTHCARE
LA1758183Medicaid
160007642OtherRAILROAD MEDICARE
LA1500674Medicaid
MS1558943OtherAMERICAN ADMIN GROUP
LA1758183Medicaid