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General NPI Number Information
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NPI Number | 1083898779
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Entity Type | Organization
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Legal Business Name | ALEXANDRIA UROLOGY P.C.
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 112 PARK LANE ROOM 5
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City | WATERLOO
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State | IA
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Zip | 50701
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Country | US
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Telephone | 319-234-2649
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Fax | 319-233-2430
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Provider Business Mailing Address
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Address Line | 112 PARK LANE
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City | WATERLOO
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State | IA
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Zip | 50701-1514
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Country | US
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Telephone | 319-234-2649
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Fax | 319-233-2430
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT EUGENE GLESNE
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Credential | M.D.
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Telephone | 319-234-2649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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