MEDICARE: FREDERICK L GLAVIN M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	ME75437	FL
2	207ZD0900X	Dermatopathology (Pathology) Physician	ME75437	FL

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	:	1558340323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK L GLAVIN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 100275
Second Line	:	1600 SW ARCHER ROAD
City	:	GAINESVILLE
State	:	FL
Zip	:	32601
Country	:	US
Telephone Number	:	352-273-7841
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 SW 35 DRIVE
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608
Country	:	US
Telephone Number	:	800-226-8968
Fax Number	:	407-856-2312

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	07/31/2008

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