Provider Demographics
NPI:1063525806
Name:GLASER, STEPHEN A (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
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 1:3600 FM 2181 STE 100
Mailing Address - Street 2:
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-7636
Mailing Address - Country:US
Mailing Address - Phone:940-497-2204
Mailing Address - Fax:940-321-4977
Practice Address - Street 1:3600 FM 2181 STE 100
Practice Address - Street 2:
Practice Address - City:HICKORY CREEK
Practice Address - State:TX
Practice Address - Zip Code:75065-7636
Practice Address - Country:US
Practice Address - Phone:940-497-2204
Practice Address - Fax:940-321-4977
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124500306Medicaid
TX20004658Medicaid
TX124500308Medicaid
TX20004658Medicaid
TX124500306Medicaid
TX8L2596Medicare PIN
TX124500308Medicaid