Provider Demographics
NPI:1770549222
Name:GLESMANN, SCOTT ARNOLD (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ARNOLD
Last Name:GLESMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HIGHWAY 95
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6803
Mailing Address - Country:US
Mailing Address - Phone:928-763-4333
Mailing Address - Fax:
Practice Address - Street 1:1800 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6803
Practice Address - Country:US
Practice Address - Phone:928-763-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ-23658207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ361709Medicaid
AZ6133040001Medicare NSC
Z119184Medicare PIN
AZ361709Medicaid
AZZWMBNSO1Medicare ID - Type Unspecified