MEDICARE: DR. IRWIN GARY GLASSMAN M.D.

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	207V00000X	Obstetrics & Gynecology Physician	4299	NV

General Provider Information

NPI Number	:	1568575801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRWIN GARY GLASSMAN M.D.

Provider Business Mailing Address
First Line	:	8906 SPANISH RIDGE AVE STE 202
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1319
Country	:	US
Telephone Number	:	702-330-3102
Fax Number	:	702-912-4994

Provider Business Practice Location Address
First Line	:	1934 E SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3842
Country	:	US
Telephone Number	:	702-369-5758
Fax Number	:	702-431-1860

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	11/10/2020

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