Individual
MR. MARK WILLIAM GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17051 DALLAS PKWY STE 400, ADDISON, TX 75001-7108
(214) 370-3535
(214) 370-0004
Mailing address
5927 E UNIVERSITY BLVD APT 221, DALLAS, TX 75206-9114
(214) 926-7117
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA02857
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209276607
—
TX
01
—
806N48
BLUE CROSS/BLUE PIN
TX
Enumeration date
08/18/2006
Last updated
03/17/2018
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