Provider Demographics
NPI:1013999374
Name:MORGAN, GLEN ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:ANDREW
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VONDERBURG DR
Mailing Address - Street 2:STE 302E
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5976
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8919
Practice Address - Street 1:611 DRUID RD E STE 511
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3942
Practice Address - Country:US
Practice Address - Phone:727-442-0500
Practice Address - Fax:727-442-0535
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08525OtherBCBS FL
FL08525ZMedicare ID - Type Unspecified
FL08525OtherBCBS FL