Provider Demographics
NPI:1407986433
Name:SAUCIER, GLEN RODNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:RODNEY
Last Name:SAUCIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:256 SW PROFESSIONAL GLN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-1104
Mailing Address - Country:US
Mailing Address - Phone:386-758-8937
Mailing Address - Fax:386-755-2169
Practice Address - Street 1:256 SW PROFESSIONAL GLN
Practice Address - Street 2:SUITE 101
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-1104
Practice Address - Country:US
Practice Address - Phone:386-758-8937
Practice Address - Fax:386-755-2169
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70187207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250258500Medicaid
FL050069055OtherRAILROAD MEDICARE
FLK1294Medicare ID - Type Unspecified