Healthcare Provider Details

I. General information

NPI: 1508823469
Provider Name (Legal Business Name): JEREL H GLASSMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHRADER STREET SUITE 600
SAN FRANCISCO CA
94117
US

IV. Provider business mailing address

1 SHRADER STREET SUITE 600
SAN FRANCISCO CA
94117
US

V. Phone/Fax

Practice location:
  • Phone: 415-503-7456
  • Fax: 415-358-8112
Mailing address:
  • Phone: 415-503-7456
  • Fax: 415-358-8112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A5877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: