Individual
EDWIN CHAPMAN GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2811 WILSHIRE BLVD, SUITE 810, SANTA MONICA, CA 90403-4803
(310) 829-9788
(310) 268-4916
Mailing address
3271 ROSEWOOD AVE, LOS ANGELES, CA 90066-1735
(310) 390-0761
(310) 268-4916
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
C35240
CA
207UN0901X
Nuclear Cardiology Physician
C35240
CA
207UN0902X
Nuclear Imaging & Therapy Physician
C35240
CA
207UN0903X
In Vivo & In Vitro Nuclear Medicine Physician
C35240
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00C352400
BLUE SHIELD
CA
05
—
00C352400
—
CA
Enumeration date
06/16/2006
Last updated
07/13/2007
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