Healthcare Provider Details

I. General information

NPI: 1639132897
Provider Name (Legal Business Name): CLIFF GLASSER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16401 NW 2ND AVE SUITE 203
NORTH MIAMI BEACH FL
33169-6036
US

IV. Provider business mailing address

3631 N 54TH AVE
HOLLYWOOD FL
33021-2339
US

V. Phone/Fax

Practice location:
  • Phone: 305-999-0009
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS4514
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: