Provider Demographics
NPI:1992851505
Name:GLASER, TROY A (DO)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:A
Last Name:GLASER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BLACK ROCK TPKE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-5508
Mailing Address - Country:US
Mailing Address - Phone:203-337-2600
Mailing Address - Fax:
Practice Address - Street 1:12800 S MEMORIAL DR STE D
Practice Address - Street 2:
Practice Address - City:BIXBY
Practice Address - State:OK
Practice Address - Zip Code:74008-2577
Practice Address - Country:US
Practice Address - Phone:918-394-2767
Practice Address - Fax:918-394-2772
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT60148207QS0010X, 207Q00000X
OK4764207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200248750AMedicaid