Healthcare Provider Details

I. General information

NPI: 1164424461
Provider Name (Legal Business Name): DENNIS N GLASCOCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SAINT FRANCIS DR STE 15
CAPE GIRARDEAU MO
63703-5049
US

IV. Provider business mailing address

211 SAINT FRANCIS DR STE 15
CAPE GIRARDEAU MO
63703-5049
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-3333
  • Fax:
Mailing address:
  • Phone: 573-331-3333
  • Fax: 573-331-3333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2005015555
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number2005015555
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: