Provider Demographics
NPI:1528157336
Name:GLASNER, JOSEPH B (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:B
Last Name:GLASNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 VETERANS WAY # B330
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-8007
Mailing Address - Country:US
Mailing Address - Phone:321-637-3788
Mailing Address - Fax:407-513-9070
Practice Address - Street 1:1980 N ATLANTIC AVE
Practice Address - Street 2:SUITE 627
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-5213
Practice Address - Country:US
Practice Address - Phone:321-783-0840
Practice Address - Fax:321-783-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME49800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
3273314001OtherCIGNA ID #
02917OtherBLUE CROSS BLUE SHIELD
10D0925036OtherCLIA #
02917OtherBLUE CROSS BLUE SHIELD
B47934Medicare UPIN