Provider Demographics
NPI:1962428599
Name:GLASS, TAMYRA D (MD)
Entity type:Individual
Prefix:
First Name:TAMYRA
Middle Name:D
Last Name:GLASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-0968
Mailing Address - Country:US
Mailing Address - Phone:559-638-2210
Mailing Address - Fax:559-638-6970
Practice Address - Street 1:1202 G ST
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-3034
Practice Address - Country:US
Practice Address - Phone:559-638-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherSSN
CA00A894370Medicare PIN