Provider Demographics
NPI:1831373919
Name:GLOGAU, RICHARD G (M D)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:GLOGAU
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PARNASSUS AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN FRANCSICO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-3608
Mailing Address - Country:US
Mailing Address - Phone:415-564-1261
Mailing Address - Fax:415-564-1967
Practice Address - Street 1:350 PARNASSUS AVENUE
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCSICO
Practice Address - State:CA
Practice Address - Zip Code:94117-3608
Practice Address - Country:US
Practice Address - Phone:415-564-1261
Practice Address - Fax:415-564-1967
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG28282207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G282820Medicare PIN