Healthcare Provider Details

I. General information

NPI: 1568424836
Provider Name (Legal Business Name): HOWARD M GLICKSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7154 MEDICAL CENTER DRIVE
SPRING HILL FL
34608-1329
US

IV. Provider business mailing address

17757 US HWY 19 NORTH SUITE 400
CLEARWATER FL
33764-6560
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-1926
  • Fax: 352-597-2154
Mailing address:
  • Phone: 727-450-2210
  • Fax: 727-450-2235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number041596
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME41596
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME41596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: