Individual
GLENN ISLAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1850 N CENTRAL AVE, SUITE 1600, PHOENIX, AZ 85004-4633
(602) 744-4765
(602) 744-4799
Mailing address
645 E MISSOURI AVE, STE 300, PHOENIX, AZ 85012-1351
(602) 262-8900
(602) 262-8890
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
21036
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
773300
—
AZ
01
—
P00044582
MEDICARE RAILROAD
—
Enumeration date
01/19/2006
Last updated
09/09/2020
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