Provider Demographics
NPI:1164486783
Name:SLOMIN, GLENN R (DO)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:R
Last Name:SLOMIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2222 S HARBOR CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5594
Mailing Address - Country:US
Mailing Address - Phone:321-541-1783
Mailing Address - Fax:321-504-0118
Practice Address - Street 1:240 N WICKHAM RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8662
Practice Address - Country:US
Practice Address - Phone:321-308-5050
Practice Address - Fax:321-984-9497
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2014-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDS5906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
080077253OtherRAIL ROAD MEDICARE
FL371129300Medicaid
080077253OtherRAIL ROAD MEDICARE
FL80333TMedicare PIN