Provider Demographics
NPI:1265468417
Name:GLAUN, RUSSEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSEL
Middle Name:S
Last Name:GLAUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1590 NW 10TH AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1313
Mailing Address - Country:US
Mailing Address - Phone:561-392-4558
Mailing Address - Fax:561-392-0041
Practice Address - Street 1:1590 NW 10TH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1313
Practice Address - Country:US
Practice Address - Phone:561-392-4558
Practice Address - Fax:561-392-0041
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70420207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG-27426Medicare UPIN
FL31311AMedicare ID - Type UnspecifiedMEDICARE NUMBER