Provider Demographics
NPI:1982682316
Name:GLASS, LOUIS HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:HOWARD
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31295
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85046-1295
Mailing Address - Country:US
Mailing Address - Phone:480-947-7401
Mailing Address - Fax:480-946-5565
Practice Address - Street 1:10290 N 92ND ST STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4528
Practice Address - Country:US
Practice Address - Phone:480-947-7401
Practice Address - Fax:480-946-5565
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ20038208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD20038Medicare PIN