Basic Information
| Provider Information | |||||||||
| NPI: | 1992851505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLASER | ||||||||
| FirstName: | TROY | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 BLACK ROCK TPKE | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068255508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033372600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12800 S MEMORIAL DR STE D | ||||||||
| Address2: | |||||||||
| City: | BIXBY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740082577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183942767 | ||||||||
| FaxNumber: | 9183942772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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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 | 207QS0010X | 60148 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207QS0010X | 4764 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine | 207Q00000X | 60148 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200248750A | 05 | OK | MEDICAID |