MEDICARE: ELYSE GLAZER D.O.

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	207R00000X	Internal Medicine Physician	OS 7268	FL

General Provider Information

NPI Number	:	1275574345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYSE GLAZER D.O.

Provider Business Mailing Address
First Line	:	21765 WESTMONT CT
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4817
Country	:	US
Telephone Number	:	954-309-6579
Fax Number	:	954-577-8107

Provider Business Practice Location Address
First Line	:	372 17TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5690
Country	:	US
Telephone Number	:	772-299-4623
Fax Number	:	772-299-4632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	04/18/2011

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