MEDICARE: DR. JULIE GLASSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0120X	Pediatric Surgery Physician	G77829	CA

General Provider Information

NPI Number	:	1063411643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE GLASSON MD

Provider Business Mailing Address
First Line	:	710 LAWRENCE EXPY
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5173
Country	:	US
Telephone Number	:	408-851-4165
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 LAWRENCE EXPY
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-5173
Country	:	US
Telephone Number	:	404-851-4165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	08/28/2023

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