Provider Demographics
NPI:1366787061
Name:JEFFREY ADELGLASS MD PA
Entity type:Organization
Organization Name:JEFFREY ADELGLASS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:ADELGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-492-6990
Mailing Address - Street 1:6020 W PARKER RD STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8175
Mailing Address - Country:US
Mailing Address - Phone:972-492-6990
Mailing Address - Fax:469-298-1488
Practice Address - Street 1:6020 W PARKER RD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8175
Practice Address - Country:US
Practice Address - Phone:972-492-6990
Practice Address - Fax:469-298-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF8786261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12062012336743OtherNPI PENDING ENUMERATION
TX1891799169OtherNPI
TX1891799169OtherNPI