Provider Demographics
NPI:1346437506
Name:GLICK, JOSEPH MAURICE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MAURICE
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:MAURICE
Other - Last Name:GLICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:4495 ROOSEVELT BLVD STE 316
Practice Address - Street 2:CREDENTIALING DEPARTMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-3356
Practice Address - Country:US
Practice Address - Phone:904-384-5222
Practice Address - Fax:904-384-6468
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105833207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00804059OtherRAILROAD MEDICARE
FLP00804059OtherRAILROAD MEDICARE