| Doctor Name: | MR. MARK WILLIAM GLASS |
| NPI Number: | 1013021161 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PA02857 |
| Business Practice Address: | 17051 Dallas Pkwy Ste 400 Addison, TX - 750017108 |
| Business Phone Number: | 2143703535 |
| Business Fax Number: | 2143700004 |
| Mailing Address: | 5927 E University Blvd Apt 221, DALLAS |
| State: | TX |
| Postal Code: | 752069114 |
| Phone Number: | 2149267117 |
| Fax Number: | |
| NPI Enumeration Date: | 08/18/2006 |
| NPI Last Update Date: | 03/04/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA02857 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |