Provider Demographics
NPI:1780640359
Name:GLASER, JEFFREY JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JAMES
Last Name:GLASER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 QUAIL HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-7229
Mailing Address - Country:US
Mailing Address - Phone:704-556-3515
Mailing Address - Fax:
Practice Address - Street 1:2200 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1587
Practice Address - Country:US
Practice Address - Phone:704-376-3947
Practice Address - Fax:704-376-9487
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC450213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1100009OtherCIGNA HEALTHCARE
NC2743512OtherUNITED HEALTHCARE
NC185581OtherMEDCOST
NC5902373Medicaid
NC017JTOtherBLUECROSS BLUESHIELD
NC017JTOtherBLUECROSS BLUESHIELD
NC185581OtherMEDCOST
NC2036238Medicare ID - Type UnspecifiedMEDICARE