Glaze, Jonathan
Glaze, Jonathan is an individual health care provider with primary practice located at 105 Asbury Cir Ste B , Hattiesburg MS 39402-1397. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Glaze, Jonathan can be contacted via phone (601) 450-8500.Contact Information
Primary practice address
105 Asbury Cir Ste B
Hattiesburg MS 39402-1397
Phone: (601) 450-8500
Fax: (601) 450-8501
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 30330 | Mississippi |
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 68334 | Tennessee |
Profile Details
| NPI number | 1821551714 |
|---|---|
| LBN Legal business name | Glaze, Jonathan |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 9th, 2019 |
| Last updated | Mar 12th, 2026 - about 8 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821551714 | NPPES |
| Tennessee | MEDICAID | Q083201 | |
| Tennessee | MEDICAID | 200005320 | |
| Tennessee | MEDICAID | 305271001 |
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