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NPI Code Detail

MEDICARE: DR. JOHN BREWER GLASS M.D.

MEDICARE: DR. JOHN BREWER GLASS 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
12084P0804XChild & Adolescent Psychiatry Physician35198MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598793804
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN BREWER GLASS M.D.
Provider Business Mailing Address
First Line : 7066 STILLWATER BLVD N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-3937
Country : US
Telephone Number : 651-777-5222
Fax Number : 651-251-5111
Provider Business Practice Location Address
First Line : 7066 STILLWATER BLVD N
Second Line :
City : OAKDALE
State : MN
Zip : 55128-3937
Country : US
Telephone Number : 651-777-5222
Fax Number : 651-251-5111
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 08/14/2012

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Directions to “ DR. JOHN BREWER GLASS M.D.” Practice Location

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