Individual
MR. MARK WILLIAM GLASS
Active
Individual
MR. MARK WILLIAM GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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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