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General NPI Number Information
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NPI Number | 1801850672
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Entity Type | Individual
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Provider Name | GLENN KEITH MORAN DO,FACOFP
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 201 NW 82ND AVE
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City | PLANTATION
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State | FL
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Zip | 33324-1856
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Country | US
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Telephone | 954-472-5100
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Fax | 954-472-5266
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Provider Business Mailing Address
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Address Line | 3201 SW 135TH TER
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City | DAVIE
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State | FL
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Zip | 33330-4647
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Country | US
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Telephone | 954-472-5100
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Fax | 954-472-5266
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS5696
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License Number State | FL
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