MEDICARE: ROBERT A GLAZER 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	170100000X	Ph.D. Medical Genetics	A358189	CA
2	207Q00000X	Family Medicine Physician	A35818	CA

General Provider Information

NPI Number	:	1447300504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT A GLAZER MD

Provider Business Mailing Address
First Line	:	5250 SANTA MONICA BLVD
Second Line	:	SUITE 208
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1252
Country	:	US
Telephone Number	:	323-913-9297
Fax Number	:	323-913-9255

Provider Business Practice Location Address
First Line	:	5250 SANTA MONICA BLVD
Second Line	:	SUITE 208
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1252
Country	:	US
Telephone Number	:	323-913-9297
Fax Number	:	323-913-9255

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	02/02/2010

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Directions to “ ROBERT A GLAZER MD” Practice Location

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