Healthcare Provider Details

I. General information

NPI: 1891724902
Provider Name (Legal Business Name): DUANE D GLASNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 NE 3RD ST
ROLLA NC
58367-0699
US

IV. Provider business mailing address

PO BOX 699
ROLLA ND
58367-0699
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-3111
  • Fax: 701-477-6342
Mailing address:
  • Phone: 701-477-3111
  • Fax: 701-477-6342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2798
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: