Individual
GARY M GLAZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
380 SIERRA COLLEGE DR, SUITE 200, GRASS VALLEY, CA 95945-5092
(916) 613-3392
(916) 266-9318
Mailing address
PO BOX 34120, RENO, NV 89533-4120
(775) 747-5050
(775) 329-8596
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
20A4983
CA
208VP0014X
Interventional Pain Medicine Physician
Primary
20A4983
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00AX49830
—
CA
Enumeration date
05/12/2006
Last updated
04/26/2023
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