Provider Demographics
NPI:1083040133
Name:GLENN MEYERS, MD
Entity Type:Organization
Organization Name:GLENN MEYERS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP SUPPORT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-500-2108
Mailing Address - Street 1:7200 CORPORATE CENTER DR
Mailing Address - Street 2:600
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1200
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:305-500-2080
Practice Address - Street 1:6971 W SUNRISE BLVD
Practice Address - Street 2:201
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-4407
Practice Address - Country:US
Practice Address - Phone:954-321-7700
Practice Address - Fax:954-584-4514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONTINUCARE MEDICAL MANAGEMENT, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52232332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site