Provider Demographics
NPI:1669697926
Name:JAMES A GLASGOW M D INC
Entity type:Organization
Organization Name:JAMES A GLASGOW M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:GLASGOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-436-5130
Mailing Address - Street 1:325 N MONTE VISTA ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4607
Mailing Address - Country:US
Mailing Address - Phone:580-436-5130
Mailing Address - Fax:580-436-1103
Practice Address - Street 1:325 N MONTE VISTA ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4607
Practice Address - Country:US
Practice Address - Phone:580-436-5130
Practice Address - Fax:580-436-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731157038001OtherBCBS
OK100100480AMedicaid
OKD39133Medicare UPIN
OK100100480AMedicaid