Healthcare Provider Details

I. General information

NPI: 1417976481
Provider Name (Legal Business Name): PETER GLASSMAN MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD VA GLA, DIVISION OF GENERAL INTERNAL MEDICINE (111G)
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

11301 WILSHIRE BLVD VA GLA, DIVISION OF GENERAL INTERNAL MEDICINE (111G)
LOS ANGELES CA
90073-1003
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-4933
Mailing address:
  • Phone: 310-478-3711
  • Fax: 310-268-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA49807
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: