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General NPI Number Information
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NPI Number | 1992851505
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Entity Type | Individual
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Provider Name | TROY A. GLASER D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 12800 S MEMORIAL DR STE D
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City | BIXBY
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State | OK
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Zip | 74008-2577
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Country | US
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Telephone | 918-394-2767
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Fax | 918-394-2772
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Provider Business Mailing Address
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Address Line | 305 BLACK ROCK TPKE
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City | FAIRFIELD
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State | CT
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Zip | 06825-5508
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Country | US
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Telephone | 203-337-2600
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 60148
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 4764
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 60148
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License Number State | CT
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