Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME89482 | FL |
NPI | 1073598744 |
---|---|
Provider Name | Mark C Glaum |
First Address | Tampa, FL 33613-3946 |
Second Address | Tampa, FL 33613-3946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 20/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I06921 | (02) | FL |