Individual
DR. TERRENCE PATRICK GLEASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1810 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5886
(928) 855-8515
(928) 854-6206
Mailing address
1972 MESQUITE AVE, LAKE HAVASU CITY, AZ 86403-5729
(928) 855-8515
(928) 854-6206
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
24347
AZ
174400000X
Specialist
MD00031165
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
340012308
RAILROAD MEDICARE ID
AZ
05
—
351271
—
AZ
01
—
AZ0395470
BC/BS PROVIDER ID
AZ
Enumeration date
11/22/2005
Last updated
03/30/2016
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