Healthcare Provider Details

I. General information

NPI: 1235220146
Provider Name (Legal Business Name): STEPHEN GLACY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9787 N 91ST ST SUITE 101
SCOTTSDALE AZ
85258-5088
US

IV. Provider business mailing address

9787 N 91ST ST SUITE 101
SCOTTSDALE AZ
85258-5088
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-8300
  • Fax: 480-860-8398
Mailing address:
  • Phone: 480-860-8300
  • Fax: 480-860-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number17082
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: