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NPI Code Detail

MEDICARE: DR. DUDLEY CRAIG GLASS MD

MEDICARE: DR. DUDLEY CRAIG GLASS 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
1207Q00000XFamily Medicine Physician52639TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1103I081669OTHERTNMEDIARE PIN
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689694887
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DUDLEY CRAIG GLASS MD
Provider Business Mailing Address
First Line : 300 20TH AVE N STE 403
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-2131
Country : US
Telephone Number : 615-396-6620
Fax Number : 615-396-6625
Provider Business Practice Location Address
First Line : 1020 N HIGHLAND AVE
Second Line :
City : MURFREESBORO
State : TN
Zip : 37130-2494
Country : US
Telephone Number : 615-396-6620
Fax Number : 615-396-6626
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 03/17/2018

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