Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | ME32731 | FL |
NPI | 1063558781 |
---|---|
Provider Name | Dr. Joel Gleason |
First Address | Seminole, FL 33776-1417 |
Second Address | St Petersburg, FL 33711-1239 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |