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General NPI Number Information
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NPI Number | 1730391590
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Entity Type | Organization
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Legal Business Name | GLEN A WASKIN DO PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1800 NORTH FEDERAL HIGHWAY SUITE 104
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City | POMPANO BEACH
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State | FL
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Zip | 33062
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Country | US
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Telephone | 954-782-0010
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Fax | 954-781-2139
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Provider Business Mailing Address
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Address Line | 1800 NORTH FEDERAL HIGHWAY SUITE 104
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City | POMPANO BEACH
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State | FL
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Zip | 33062
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Country | US
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Telephone | 954-782-0010
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Fax | 954-781-2139
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Authorized Official
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Title or Position | PRESIDENT
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Name | GLEN ANDREW WASKIN
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Credential | DO
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Telephone | 954-782-0010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS8048
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License Number State | FL
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