Healthcare Provider Details

I. General information

NPI: 1982682316
Provider Name (Legal Business Name): LOUIS HOWARD GLASS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10290 N 92ND ST STE 200
SCOTTSDALE AZ
85258-4528
US

IV. Provider business mailing address

PO BOX 31295
PHOENIX AZ
85046-1295
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-7401
  • Fax: 480-946-5565
Mailing address:
  • Phone: 480-947-7401
  • Fax: 480-946-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20038
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: