MEDICARE: GLT MEDICAL SERVICES LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	34004485	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194708461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLT MEDICAL SERVICES LTD

Provider Business Mailing Address
First Line	:	111 CLINTON ST
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-2811
Country	:	US
Telephone Number	:	419-893-0485
Fax Number	:	419-893-1255

Provider Business Practice Location Address
First Line	:	111 CLINTON ST
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-2811
Country	:	US
Telephone Number	:	419-893-0485
Fax Number	:	419-893-1255

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JOSEPH STANLEY PEYTON
Credential	:	D.O.
Telephone Number	:	419-893-0485

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	12/08/2009

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Directions to “GLT MEDICAL SERVICES LTD ” Practice Location

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