Healthcare Provider Details

I. General information

NPI: 1336362904
Provider Name (Legal Business Name): TODD DANIEL GLASSMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW 84TH AVE STE 200
PLANTATION FL
33324-1847
US

IV. Provider business mailing address

4780 SW 64TH AVE STE 103
DAVIE FL
33314-4400
US

V. Phone/Fax

Practice location:
  • Phone: 954-577-2294
  • Fax: 954-577-2297
Mailing address:
  • Phone: 954-434-1705
  • Fax: 800-642-2398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS7563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: