Provider Demographics
NPI:1467568915
Name:GLADDING, LLOYD DAWSON (DO)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:DAWSON
Last Name:GLADDING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 KENNESAW ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-7526
Mailing Address - Country:US
Mailing Address - Phone:239-425-6464
Mailing Address - Fax:239-432-0548
Practice Address - Street 1:3095 KENNESAW ST
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33916-7526
Practice Address - Country:US
Practice Address - Phone:239-425-6464
Practice Address - Fax:239-432-0548
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3902204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE32177Medicare UPIN
FL82216VMedicare ID - Type Unspecified