Basic Information
| Provider Information | |||||||||
| NPI: | 1013959642 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY B GLASER MD MEDICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16311 VENTURA BLVD | ||||||||
| Address2: | SUITE #518 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185017246 | ||||||||
| FaxNumber: | 8185017247 | ||||||||
| Practice Location | |||||||||
| Address1: | 16311 VENTURA BLVD | ||||||||
| Address2: | SUITE #518 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185017246 | ||||||||
| FaxNumber: | 8185017247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | GLASER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 8187440505 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207LP2900X | A64352 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.