Provider Demographics
NPI:1689694887
Name:GLASS, DUDLEY CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:CRAIG
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CRAIG
Other - Middle Name:
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-396-6620
Mailing Address - Fax:615-396-6625
Practice Address - Street 1:1020 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2494
Practice Address - Country:US
Practice Address - Phone:615-396-6620
Practice Address - Fax:615-396-6626
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52639207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I081669OtherMEDIARE PIN
TNQ013636Medicaid
TX8D8802Medicare ID - Type Unspecified