Provider Demographics
NPI:1992021554
Name:GLASS, ALLISON SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:SUE
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1321 COTTONWOOD ST FL 3
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5131
Practice Address - Country:US
Practice Address - Phone:530-668-2600
Practice Address - Fax:530-661-3034
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2021-08-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA118062208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty