Provider Demographics
NPI:1093945867
Name:MANZANO, GLEN ROCKY (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:ROCKY
Last Name:MANZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7460 DOCS GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8010
Mailing Address - Country:US
Mailing Address - Phone:407-423-7172
Mailing Address - Fax:407-423-9505
Practice Address - Street 1:7460 DOCS GROVE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8010
Practice Address - Country:US
Practice Address - Phone:407-423-7172
Practice Address - Fax:407-423-9505
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME104328207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery