Individual provider · NPI-1
Clinton Earl Glass Sr., P.A.
Physician Assistant, Medical · Smyrna, DE
NPI number1093050098
StatusActive
Last updated in NPPESDec 1, 2012
Details
- NPI
- 1093050098
- Entity type
- Individual (NPI-1)
- Name
- Mr. Clinton Earl Glass Sr.
- Credential
- P.A.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 1, 2012
- Last updated
- Dec 1, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | C5-0000852 | DE | Yes |
| 207QA0000X | Family Medicine, Adolescent Medicine | C5-0000852 | DE |
Practice location
51 Deak DrSuite 1 First Fl.
Smyrna, DE 19977-1268
Phone 302-653-1281 · Fax 302-653-1283
Mailing address
51 Deak DrSuite 1 First Fl.
Smyrna, DE 19977-1268
Phone 302-653-1281 · Fax 302-653-1283
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