Provider Demographics
NPI:1235718610
Name:GLASS-HICKS, ANNLEE-TAYLOR ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ANNLEE-TAYLOR
Middle Name:ELIZABETH
Last Name:GLASS-HICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNLEE-TAYLOR
Other - Middle Name:ELIZABETH
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2600 LINDA KAY DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72206-5486
Mailing Address - Country:US
Mailing Address - Phone:501-278-1418
Mailing Address - Fax:
Practice Address - Street 1:1300 W TERRELL AVE STE K230
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3104
Practice Address - Country:US
Practice Address - Phone:817-250-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU6243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program