Individual
JONATHAN GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF MEDICINE, SHREVEPORT, LA 71103-4228
(318) 675-7737
(318) 675-5666
Mailing address
1501 KINGS HWY, DEPARTMENT OF MEDICINE, SHREVEPORT, LA 71103-4228
(318) 675-7737
(318) 675-5666
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
07012R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1358584
—
LA
Enumeration date
07/21/2006
Last updated
07/08/2007
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