Healthcare Provider Details

I. General information

NPI: 1558321992
Provider Name (Legal Business Name): WILLIAM HARVEY GLOS CST/CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4868 WYANDOT ST
DENVER CO
80221-1368
US

IV. Provider business mailing address

4868 WYANDOT ST
DENVER CO
80221-1368
US

V. Phone/Fax

Practice location:
  • Phone: 303-455-8812
  • Fax: 303-480-1109
Mailing address:
  • Phone: 303-455-8812
  • Fax: 303-480-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberCERTIFICATION 90771
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: