Provider Demographics
NPI:1538293980
Name:GLENN J. BARQUET, MD, PA
Entity Type:Organization
Organization Name:GLENN J. BARQUET, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARQUET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-856-1064
Mailing Address - Street 1:4100 S RED RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5319
Mailing Address - Country:US
Mailing Address - Phone:305-856-1064
Mailing Address - Fax:305-856-0644
Practice Address - Street 1:4100 S RED RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5319
Practice Address - Country:US
Practice Address - Phone:305-856-1064
Practice Address - Fax:305-856-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81112207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260970300Medicaid
FLK7423Medicare PIN
FL58726Medicare UPIN