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General NPI Number Information
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NPI Number | 1629462502
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Entity Type | Individual
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Provider Name | ALEX LEV GLOTSER M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 1501 KINGS HWY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-675-4147
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Fax |
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Provider Business Mailing Address
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Address Line | 2381 TALLGRASS CIR
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City | BOSSIER CITY
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State | LA
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Zip | 71111-6730
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Country | US
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Telephone | 504-344-9975
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 306506
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 306506
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License Number State | LA
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