Healthcare Provider Details

I. General information

NPI: 1730165721
Provider Name (Legal Business Name): DAVID GLASER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 NW MERCY DR SUITE 350
ROSEBURG OR
97471-2348
US

IV. Provider business mailing address

2750 W HARVARD AVE
ROSEBURG OR
97471-2608
US

V. Phone/Fax

Practice location:
  • Phone: 541-677-4488
  • Fax: 541-677-4478
Mailing address:
  • Phone: 541-673-8988
  • Fax: 541-672-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD24724
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: