=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629306311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLASER FAMILY MEDICAL CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2009
-----------------------------------------------------
Last Update Date | 11/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1017 PROFESSIONAL PARK DR
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-4886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-643-9000
-----------------------------------------------------
Fax | 813-643-9001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1017 PROFESSIONAL PARK DR
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33511-4886
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-643-9000
-----------------------------------------------------
Fax | 813-643-9001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | HERMANDA GLASER
-----------------------------------------------------
Credential | M.D., P.A.
-----------------------------------------------------
Telephone | 813-643-9000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------