Provider Demographics
NPI:1447366943
Name:GLASS, RICHARD WALLACE (SA (PA))
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WALLACE
Last Name:GLASS
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Gender:M
Credentials:SA (PA)
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Mailing Address - Street 1:29 MARY ANN LN
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-4346
Mailing Address - Country:US
Mailing Address - Phone:205-467-3475
Mailing Address - Fax:205-558-4732
Practice Address - Street 1:700 19TH ST S
Practice Address - Street 2:SURGICAL SVC (112)
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1927
Practice Address - Country:US
Practice Address - Phone:205-933-8101
Practice Address - Fax:205-558-4732
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical