Basic Information
| Provider Information | |||||||||
| NPI: | 1285636126 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLAZER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 COLE AVE | ||||||||
| Address2: | |||||||||
| City: | BISBEE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856031327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5204326481 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10524 E HIGHWAY 92 | ||||||||
| Address2: | |||||||||
| City: | HEREFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203660300 | ||||||||
| FaxNumber: | 5203660440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 08/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 007561 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | Z216210 | 01 | AZ | MEDICARE | OTHER | 400232 | 05 | AZ | MEDICAID |