Provider Demographics
NPI:1801841259
Name:GLASSMAN, ANTHONY LEE (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:LEE
Last Name:GLASSMAN
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:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0414
Mailing Address - Country:US
Mailing Address - Phone:541-673-8988
Mailing Address - Fax:541-672-8103
Practice Address - Street 1:1813 W HARVARD AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2752
Practice Address - Country:US
Practice Address - Phone:541-677-6013
Practice Address - Fax:541-677-6028
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD20054208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR084421Medicaid
ORR137599Medicare PIN