Basic Information
| Provider Information | |||||||||
| NPI: | 1619929726 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENNIS N GLASCOCK, DO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 VANCE RD | ||||||||
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| City: | VALLEY PARK | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630881527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362255445 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 1ST CAPITOL DR | ||||||||
| Address2: | STE 270 | ||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633012835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369165551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GLASCOCK | ||||||||
| AuthorizedOfficialFirstName: | DENNIS | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6369165551 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
No ID Information.