Healthcare Provider Details

I. General information

NPI: 1184610263
Provider Name (Legal Business Name): JEFFREY A. GLEZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 LAKESHORE DR
OLD HICKORY TN
37138-2212
US

IV. Provider business mailing address

3223 LAKESHORE DR
OLD HICKORY TN
37138-2212
US

V. Phone/Fax

Practice location:
  • Phone: 217-979-9396
  • Fax: --
Mailing address:
  • Phone: 217-979-9396
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28505
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: