Provider Demographics
NPI:1104912856
Name:GLASGOW, SEAN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:CHRISTOPHER
Last Name:GLASGOW
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Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8109-37-915
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-7177
Mailing Address - Fax:888-425-7946
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DIV SURG COLON/RECTAL, STE 310
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-454-7177
Practice Address - Fax:888-425-7946
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2022-12-12
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Provider Licenses
StateLicense IDTaxonomies
MO2003029889208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200007826Medicaid
ILENROLLEDMedicaid