Provider Demographics
NPI:1710992318
Name:RICHARD S GLOSSER MD PA
Entity Type:Organization
Organization Name:RICHARD S GLOSSER MD PA
Other - Org Name:HOMESTEAD ORTHOPEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-248-6311
Mailing Address - Street 1:941 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4408
Mailing Address - Country:US
Mailing Address - Phone:305-248-6311
Mailing Address - Fax:305-242-5559
Practice Address - Street 1:941 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4408
Practice Address - Country:US
Practice Address - Phone:305-248-6311
Practice Address - Fax:305-242-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51532207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1016686OtherOTHER ID NUMBER-COMMERCIAL NUMBER
FLFS467AOtherPTAN
FLFS467AMedicare UPIN