Provider Demographics
NPI:1851400642
Name:GLASGOW, JAMES ALDEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALDEN
Last Name:GLASGOW
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 1:325 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4607
Mailing Address - Country:US
Mailing Address - Phone:580-436-5130
Mailing Address - Fax:580-436-1103
Practice Address - Street 1:325 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4607
Practice Address - Country:US
Practice Address - Phone:580-436-5130
Practice Address - Fax:580-436-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731157038001OtherBCBS
OKCR0998OtherPALMETTO GBA - RAILROAD M
OK100100480AMedicaid
OKD39133Medicare UPIN
OK100100480AMedicaid