Healthcare Provider Details

I. General information

NPI: 1992851505
Provider Name (Legal Business Name): TROY A. GLASER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 S MEMORIAL DR STE D
BIXBY OK
74008-2577
US

IV. Provider business mailing address

305 BLACK ROCK TPKE
FAIRFIELD CT
06825-5508
US

V. Phone/Fax

Practice location:
  • Phone: 918-394-2767
  • Fax: 918-394-2772
Mailing address:
  • Phone: 203-337-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number60148
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4764
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number60148
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: