Provider Demographics
NPI:1336362904
Name:GLASSMAN, TODD DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DANIEL
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:800-642-2398
Practice Address - Street 1:350 NW 84TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1847
Practice Address - Country:US
Practice Address - Phone:954-577-2294
Practice Address - Fax:954-577-2297
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2020-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS7563207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265784800Medicaid
FLL4361OtherMEDICARE
G99594Medicare UPIN