Individual
JUSTIN A GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 367-6030
(208) 322-7018
Mailing address
777 N RAYMOND ST, BOISE, ID 83704-9251
(208) 367-6030
(208) 322-7018
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
56066
GA
207Q00000X
Family Medicine Physician
Primary
M-10405
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194820852
—
NM
05
—
42701279
—
CO
05
—
565179
—
AZ
05
—
807782300
—
ID
05
—
808154100
—
ID
01
—
8HD081
SANOSTEE MEDICARE PIN
—
01
—
8HD082
TOADALENA MEDICARE PIN
—
01
—
8HZ07C
NNMC MEDICARE PIN
—
Enumeration date
09/14/2006
Last updated
07/22/2009
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