Provider Demographics
NPI:1063780559
Name:GLAZER, RACHAEL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RACHAEL
Middle Name:
Last Name:GLAZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 TUSCAN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3837
Mailing Address - Country:US
Mailing Address - Phone:972-401-3200
Mailing Address - Fax:
Practice Address - Street 1:701 TUSCAN DR STE 200
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3837
Practice Address - Country:US
Practice Address - Phone:972-401-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05650364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health