Provider Demographics
NPI:1932209061
Name:GLASSON, CYNTHIA LOUISE (DO)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:GLASSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39649-0490
Mailing Address - Country:US
Mailing Address - Phone:601-250-4366
Mailing Address - Fax:601-250-4367
Practice Address - Street 1:300 RAWLS DR STE 600
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2862
Practice Address - Country:US
Practice Address - Phone:601-249-4415
Practice Address - Fax:601-249-4474
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICG011459207Q00000X
MS33435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3364670Medicaid
MI010000827OtherHEALTH PLUS
MI107505OtherCARE CHOICE
MIC6279OtherM-CARE
MI1982630612Medicaid
MI5631225OtherBCBS
MI1982630612Medicaid
MI3364670Medicaid
MI0P01430Medicare ID - Type Unspecified