Healthcare Provider Details

I. General information

NPI: 1609889831
Provider Name (Legal Business Name): JAMES GIRARD GLAUBER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CLAYTON RD STE 302
ST LOUIS MO
63117-1850
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-1850
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-3432
  • Fax: 314-645-3191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number106832
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: