Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | ME0072954 | FL |
NPI | 1285611582 |
---|---|
Provider Name | Dr. Glenn L Zellman |
First Address | Phoenix, AZ 85021-5099 |
Second Address | Phoenix, AZ 85021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 24/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G63661 | (02) | FL |