Healthcare Provider Details

I. General information

NPI: 1225035181
Provider Name (Legal Business Name): GLEN D ROWE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 09/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 SW 160TH AVE SUITE 250
MIRAMAR FL
33027-6308
US

IV. Provider business mailing address

640 S STATE ST 742 BUILDING
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 877-866-7123
  • Fax: 855-855-2792
Mailing address:
  • Phone: 302-674-3970
  • Fax: 302-672-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC20003481
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2015-00314
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: