Healthcare Provider Details

I. General information

NPI: 1043282569
Provider Name (Legal Business Name): TEJINDER S GLAMOUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 66TH ST N
PINELLAS PARK FL
33781-5025
US

IV. Provider business mailing address

3001 EXECUTIVE DR STE 130
CLEARWATER FL
33762-5323
US

V. Phone/Fax

Practice location:
  • Phone: 727-521-0994
  • Fax: 727-522-2671
Mailing address:
  • Phone: 727-347-0005
  • Fax: 727-541-6558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberME68156
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME68156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: