Provider Demographics
NPI:1891799169
Name:ADELGLASS, JEFFREY M (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:ADELGLASS
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 1:6020 W PARKER RD
Mailing Address - Street 2:STE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-7900
Mailing Address - Country:US
Mailing Address - Phone:972-492-6990
Mailing Address - Fax:972-394-4405
Practice Address - Street 1:6020 W PARKER RD
Practice Address - Street 2:STE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7900
Practice Address - Country:US
Practice Address - Phone:972-492-6990
Practice Address - Fax:972-394-4405
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX88X481OtherBLUE CROSS BLUE SHEILD
TX085438201Medicaid
TX085438201Medicaid
TX88X481Medicare ID - Type Unspecified
TXB20783Medicare UPIN