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General NPI Number Information
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NPI Number | 1487785879
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Entity Type | Individual
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Provider Name | GLENN PETER GWOZDZ MD
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Gender | Male
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 35 BILL FRIES DR BLDG F
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City | HILTON HEAD
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State | SC
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Zip | 29926-2730
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Country | US
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Telephone | 843-681-6668
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Fax | 843-681-3295
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Provider Business Mailing Address
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Address Line | 35 BILL FRIES DR BLDG F
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City | HILTON HEAD
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State | SC
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Zip | 29926-2730
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Country | US
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Telephone | 843-681-6668
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Fax | 843-681-3295
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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 | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 14617
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License Number State | SC
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