Individual
JONATHAN GLAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
105 ASBURY CIR STE B, HATTIESBURG, MS 39402-1397
(601) 450-8500
(601) 450-8501
Mailing address
105 ASBURY CIR STE B, HATTIESBURG, MS 39402-1397
(601) 450-8500
(601) 450-8501
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
30330
MS
207W00000X
Ophthalmology Physician
68334
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200005320
—
MS
05
—
305271001
—
AR
05
—
Q083201
—
TN
Enumeration date
04/09/2019
Last updated
03/12/2026
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