Provider Demographics
NPI:1588658231
Name:ADAMS, GLENN D (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:D
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 BEE RIDGE RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2514
Mailing Address - Country:US
Mailing Address - Phone:941-917-8772
Mailing Address - Fax:941-365-7057
Practice Address - Street 1:1625 S OSPREY AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2929
Practice Address - Country:US
Practice Address - Phone:941-917-8772
Practice Address - Fax:941-365-7057
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME44375207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30723OtherBCBS
FL069755900Medicaid
FL202858219OtherTAX ID
FL069755900Medicaid
FL202858219OtherTAX ID