Provider Demographics
NPI:1487615720
Name:GLASS, JEFFREY L (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 CHICHESTER PL
Mailing Address - Street 2:
Mailing Address - City:ALAMO HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:78209-5307
Mailing Address - Country:US
Mailing Address - Phone:210-381-2821
Mailing Address - Fax:830-643-0737
Practice Address - Street 1:876 TX-337 LOOP, SUITE 101
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3553
Practice Address - Country:US
Practice Address - Phone:830-624-7993
Practice Address - Fax:830-643-0737
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH9953208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136761706Medicaid
TXF01364Medicare UPIN
TX136761706Medicaid