Provider Demographics
NPI:1255894119
Name:GLASSER, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:GLASSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 26TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2412
Mailing Address - Country:US
Mailing Address - Phone:205-332-3155
Mailing Address - Fax:866-644-8086
Practice Address - Street 1:1020 26TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-2412
Practice Address - Country:US
Practice Address - Phone:205-332-3155
Practice Address - Fax:866-644-8086
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-08
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46157207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine