Healthcare Provider Details

I. General information

NPI: 1326157553
Provider Name (Legal Business Name): GLENN M BUYO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E HILLSBORO BLVD STE 210
DEERFIELD BEACH FL
33441-4348
US

IV. Provider business mailing address

3 W OLIVE ST SUITE 201
SCRANTON PA
18508-2572
US

V. Phone/Fax

Practice location:
  • Phone: 954-419-9632
  • Fax: 954-419-9334
Mailing address:
  • Phone: 570-961-9947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS013728
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: