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General NPI Number Information
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NPI Number | 1497819577
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Entity Type | Individual
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Provider Name | GLENN EARL GABORKO JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF CENTRAL FLORIDA STUDENT HEALTH SERVICES BUILDING 127
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City | ORLANDO
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State | FL
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Zip | 32816-0001
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Country | US
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Telephone | 407-823-1616
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Fax | 407-823-1611
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Provider Business Mailing Address
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Address Line | 2147 WESTBOURNE DR
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City | OVIEDO
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State | FL
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Zip | 32765-5159
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Country | US
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Telephone | 407-687-4577
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Fax | 407-823-1611
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2637
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License Number State | FL
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