Healthcare Provider Details

I. General information

NPI: 1780637322
Provider Name (Legal Business Name): GLENN HAMBURG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N ROCKY POINT DR E STE 185
TAMPA FL
33607-5810
US

IV. Provider business mailing address

3001 N ROCKY POINT DR E STE 185
TAMPA FL
33607-5810
US

V. Phone/Fax

Practice location:
  • Phone: 813-289-9613
  • Fax:
Mailing address:
  • Phone: 813-289-9613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME71011
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: