Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | ME111854 | FL |
N | 2080P0204X | Pediatric Emergency Doctor | 35-07-4850 | OH |
NPI | 1225066335 |
---|---|
Provider Name | Todd F Glass |
First Address | Rockland, DE 19732-0191 |
Second Address | Orlando, FL 32806-2946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 06/04/2012 |