Provider Demographics
NPI:1053415117
Name:GLAZENER, LEIGHANNE (MD)
Entity type:Individual
Prefix:MRS
First Name:LEIGHANNE
Middle Name:
Last Name:GLAZENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7121 S PADRE ISLAND DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4938
Mailing Address - Country:US
Mailing Address - Phone:361-851-5000
Mailing Address - Fax:361-851-8053
Practice Address - Street 1:7121 S PADRE ISLAND DR
Practice Address - Street 2:SUITE 302
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4938
Practice Address - Country:US
Practice Address - Phone:361-851-5000
Practice Address - Fax:361-851-8053
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7973207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036294901Medicaid
G03814Medicare UPIN
TX036294901Medicaid