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General NPI Number Information
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NPI Number | 1750384830
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Entity Type | Individual
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Provider Name | JONATHAN K GLAZER M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 3725 11TH CIR
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City | VERO BEACH
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State | FL
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Zip | 32960-4804
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Country | US
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Telephone | 772-562-0163
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Fax | 772-562-1505
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Provider Business Mailing Address
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Address Line | 3725 11TH CIR
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City | VERO BEACH
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State | FL
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Zip | 32960-4804
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Country | US
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Telephone | 772-562-0163
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Fax | 772-562-1505
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 45283
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME90452
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License Number State | FL
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