Provider Demographics
NPI:1487837480
Name:EDWARD GLAVEY D O LLC
Entity Type:Organization
Organization Name:EDWARD GLAVEY D O LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLAVEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DO
Authorized Official - Phone:863-299-5424
Mailing Address - Street 1:PO BOX 3293
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-1000
Mailing Address - Country:US
Mailing Address - Phone:863-299-5424
Mailing Address - Fax:863-647-2410
Practice Address - Street 1:575 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3054
Practice Address - Country:US
Practice Address - Phone:863-299-5424
Practice Address - Fax:863-647-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10216208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS10216OtherLICENSE
FLAJ590Medicare PIN