Healthcare Provider Details

I. General information

NPI: 1285636126
Provider Name (Legal Business Name): JOHN GLAZER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 S LENZNER AVE
SIERRA VISTA AZ
85635-5685
US

IV. Provider business mailing address

286 S LENZNER AVE
SIERRA VISTA AZ
85635-5685
US

V. Phone/Fax

Practice location:
  • Phone: 520-452-0388
  • Fax: 877-281-8622
Mailing address:
  • Phone: 520-452-0388
  • Fax: 877-281-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number007561
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: