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NPI Code Detail

MEDICARE: MR. MARK WILLIAM GLASS

MEDICARE: MR. MARK WILLIAM GLASS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA02857TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2806N48OTHERTXBLUE CROSS/BLUE PIN

General Provider Information

NPI Number : 1013021161
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK WILLIAM GLASS
Provider Business Mailing Address
First Line : 5927 E UNIVERSITY BLVD APT 221
Second Line :
City : DALLAS
State : TX
Zip : 75206-9114
Country : US
Telephone Number : 214-926-7117
Fax Number :
Provider Business Practice Location Address
First Line : 17051 DALLAS PKWY STE 400
Second Line :
City : ADDISON
State : TX
Zip : 75001-7108
Country : US
Telephone Number : 214-370-3535
Fax Number : 214-370-0004
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 03/17/2018

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Directions to “ MR. MARK WILLIAM GLASS ” Practice Location

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