Basic Information
| Provider Information | |||||||||
| NPI: | 1487641635 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLAESER | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 VOLKER HALL | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056389587 | ||||||||
| FaxNumber: | 2059754623 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 7TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2056389587 | ||||||||
| FaxNumber: | 2059754623 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD.19725 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | MD.19725 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0204X | MD.19725 | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 009928440 | 05 | AL | MEDICAID | 101880 | 05 | AL | MEDICAID | 4480557 | 01 | AL | AETNA | OTHER | 510-95300 | 01 | AL | BCBS | OTHER | 1487641635 | 01 | AL | TRICARE SOUTH | OTHER | 510-45712 | 01 | AL | BCBS | OTHER |