Most Relevant Information
Provider Data
| NPI Number: | 1003219304 |
| Provider Name: | CHARLES C GLASS PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 2015022139 |
Most Important Dates
| Enumeration Date: | 09/30/2014 |
| Last Updated: | 07/08/2021 |
Provider Practice Location
3550 S 4TH ST STE 250
LEAVENWORTH
KS
660485061
Practice Location Phone/Fax
| Phone: | 9135652569 |
| Fax: | 9135652571 |
Provider Mailing Location
2200 SW 6TH AVE STE 104
TOPEKA
KS
666061707
Provider Mailing Phone/Fax
| Phone: | 7853548518 |
| Fax: | 7853541255 |