Individual
M MARTIA GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
US HWY 491 N, SHIPROCK, NM 87420
(505) 368-6401
(505) 368-6431
Mailing address
PO BOX 160, SHIPROCK, NM 87420-0160
(505) 368-6401
(505) 368-6431
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
81204
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
62300733
—
CO
05
—
689870
—
AZ
05
—
Q9721
—
NM
Enumeration date
12/27/2005
Last updated
12/26/2007
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