Provider Demographics
NPI:1952331233
Name:GLASNER, GREGORY C (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:GLASNER
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 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6907207V00000X
MN35037207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0701526OtherMEDICA #
ND2138OtherSIOUX VALLEY #
ND67D33GLOtherMNBS #
ND6D409GLOtherMNBS #
ND0702339OtherMEDICA #
ND18054Medicaid
ND908013900Medicaid
ND12438OtherNDBS #
NDDA9011015535OtherPREFERRED ONE #
NDHP19500OtherHEALTHPARTNERS #
NDND200018OtherLHS #
ND0701525OtherMEDICA #
ND142011OtherUCARE #
ND17945OtherNDBS #
ND2138OtherSIOUX VALLEY #
ND17945Medicare ID - Type UnspecifiedND MEDICARE #
ND160044711Medicare ID - Type UnspecifiedRR MEDICARE #
ND12438OtherNDBS #
ND67D33GLOtherMNBS #
ND908013900Medicaid