Provider Demographics
NPI:1083672067
Name:GLASER, BRIAN DALE (DO)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:DALE
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 1:3400 LONG PRAIRIE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-2706
Mailing Address - Country:US
Mailing Address - Phone:972-899-6300
Mailing Address - Fax:972-899-6020
Practice Address - Street 1:3400 LONG PRAIRIE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-2706
Practice Address - Country:US
Practice Address - Phone:972-899-6300
Practice Address - Fax:972-899-6020
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG82633Medicare UPIN
TX00471WMedicare ID - Type UnspecifiedGROUP NUMBER