Healthcare Provider Details

I. General information

NPI: 1396184503
Provider Name (Legal Business Name): GLENN MEYERS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 06/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 HOLLYWOOD BLVD 2ND FLOOR
HOLLYWOOD FL
33021-6422
US

IV. Provider business mailing address

7200 CORPORATE CENTER DR
MIAMI FL
33126-1200
US

V. Phone/Fax

Practice location:
  • Phone: 954-981-5200
  • Fax: 954-981-1614
Mailing address:
  • Phone: 305-500-2000
  • Fax: 305-500-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberME52232
License Number StateFL

VIII. Authorized Official

Name: HOLLY LOPEZ
Title or Position: VP SUPPORT SERVICES
Credential:
Phone: 305-500-2108