Provider Demographics
NPI:1356611727
Name:PARKER, GLENN M (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:M
Last Name:PARKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1700 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4107
Mailing Address - Country:US
Mailing Address - Phone:954-939-3290
Mailing Address - Fax:954-939-3288
Practice Address - Street 1:1700 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4107
Practice Address - Country:US
Practice Address - Phone:954-939-3290
Practice Address - Fax:954-939-3288
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME67261208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice