Healthcare Provider Details

I. General information

NPI: 1104912856
Provider Name (Legal Business Name): SEAN CHRISTOPHER GLASGOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 12/12/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 N MASON RD DIV SURG COLON/RECTAL, STE 310
SAINT LOUIS MO
63141-6431
US

IV. Provider business mailing address

660 S EUCLID AVE MSC 8109-37-915
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-7177
  • Fax: 888-425-7946
Mailing address:
  • Phone: 314-454-7177
  • Fax: 888-425-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2003029889
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number2003029889
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: