=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326157553
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GLENN M BUYO DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1500 E HILLSBORO BLVD STE 210
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33441-4348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-419-9632
-----------------------------------------------------
Fax | 954-419-9334
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3 W OLIVE ST SUITE 201
-----------------------------------------------------
City | SCRANTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18508-2572
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-961-9947
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS013728
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------