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General NPI Number Information
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NPI Number | 1508083130
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Entity Type | Organization
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Legal Business Name | WESLEY S. GLAZENER, MD, PA
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1305 W 34TH ST #206
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City | AUSTIN
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State | TX
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Zip | 78705-1923
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Country | US
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Telephone | 512-454-8691
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Fax | 512-454-4238
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Provider Business Mailing Address
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Address Line | 1305 W 34TH ST #206
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City | AUSTIN
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State | TX
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Zip | 78705-1923
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Country | US
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Telephone | 512-454-8691
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Fax | 512-454-4238
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Authorized Official
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Title or Position | OWNER
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Name | DR. WESLEY STANTON GLAZENER
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Credential | MD
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Telephone | 512-454-8691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | H7305
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License Number State | TX
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