1427190842 NPI number — DR. RICHARD LEE GLAZE M.D.

Table of content: DR. RICHARD LEE GLAZE M.D. (NPI 1427190842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427190842 NPI number — DR. RICHARD LEE GLAZE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLAZE
Provider First Name:
RICHARD
Provider Middle Name:
LEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427190842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2401 VILLAGE PROFESSIONAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELIKA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36801-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-749-8121
Provider Business Mailing Address Fax Number:
334-749-6166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 VILLAGE PROFESSIONAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OPELIKA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36801-4702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-749-8121
Provider Business Practice Location Address Fax Number:
334-749-6166
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  26042 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 969760 . This is a "AAP ID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 26042 . This is a "ALABAMA MEDICAL LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 26042 . This is a "ALABAMA CONTR SUBST CERT" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-22780 . This is a "BCBS AL PROV # AUBURN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 515-22766 . This is a "BCBS AL PROV # OPELIKA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com