Provider Demographics
NPI:1821618430
Name:GLADE, DANIEL (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:GLADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9018 CULEBRA RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2891
Mailing Address - Country:US
Mailing Address - Phone:830-261-3212
Mailing Address - Fax:830-276-2626
Practice Address - Street 1:680 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-2241
Practice Address - Country:US
Practice Address - Phone:801-766-1699
Practice Address - Fax:801-766-4526
Is Sole Proprietor?:No
Enumeration Date:2020-04-23
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXU8724207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology