Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CH-0005881 | FL |
NPI | 1356416671 |
---|---|
Provider Name | Dr. Glen Scott Thornton |
First Address | Brandon, FL 33511-6121 |
Second Address | Brandon, FL 33511-6121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 04/08/2010 |