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General NPI Number Information
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NPI Number | 1386074508
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Entity Type | Individual
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Provider Name | GLEN LALLJIE MD
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Gender | Male
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Dates
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Enumeration Date | 11/25/2013
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Last Update Date | 11/25/2013
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Provider Practice Location Address
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Address Line | SUITE F204 BAYWEST CENTER HARBOUR STREET
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City | MONTEGO BAY
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State | ST. JAMES
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Zip | 00000
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Country | JM
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Telephone | 876-940-1106
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Fax |
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Provider Business Mailing Address
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Address Line | SUITE F204 BAYWEST CENTER HARBOUR STREET
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City | MONTEGO BAY
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State | ST. JAMES
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Zip | 00000
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Country | JM
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Telephone | 876-940-1106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME86463
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License Number State | FL
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