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NPI Code Detail

MEDICARE: DR. GLENN WILLIAM STAMBO M.D.

MEDICARE: DR. GLENN WILLIAM STAMBO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistME76556FL
22085R0202XDiagnostic Radiology PhysicianME76556FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300130409OTHERFLRR MCR
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003881350
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLENN WILLIAM STAMBO M.D.
Provider Business Mailing Address
First Line : PO BOX 403444
Second Line :
City : ATLANTA
State : GA
Zip : 30384-3444
Country : US
Telephone Number : 813-348-6951
Fax Number : 813-348-6999
Provider Business Practice Location Address
First Line : 14055 RIVEREDGE DR STE 250
Second Line :
City : TAMPA
State : FL
Zip : 33637-2141
Country : US
Telephone Number : 813-929-5451
Fax Number : 813-929-5465
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 08/11/2025

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