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General NPI Number Information
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NPI Number | 1881670636
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Entity Type | Individual
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Provider Name | RICHARD D. GLOCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 01/13/2016
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Provider Practice Location Address
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Address Line | 8614 BAYMEADOWS WAY #100
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City | JACKSONVILLE
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State | FL
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Zip | 32256-8236
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Country | US
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Telephone | 904-396-0450
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Fax | 904-346-0212
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Provider Business Mailing Address
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Address Line | 8614 BAYMEADOWS WAY #100
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City | JACKSONVILLE
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State | FL
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Zip | 32256-8236
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Country | US
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Telephone | 904-396-0450
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Fax | 904-346-0212
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0023128
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME23128
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License Number State | FL
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