Healthcare Provider Details

I. General information

NPI: 1235343674
Provider Name (Legal Business Name): SARA GLASSGOW D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 01/02/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 CROW CREEK RD
BETTENDORF IA
52722-2066
US

IV. Provider business mailing address

3601 SW 160TH AVE STE 250
MIRAMAR FL
33027-6314
US

V. Phone/Fax

Practice location:
  • Phone: 954-399-4673
  • Fax: 815-454-2832
Mailing address:
  • Phone: 954-399-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-04637
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-126499
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036-126499
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO-04637
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: