Provider Demographics
NPI:1730204918
Name:GLENN A. TOVAR DIAS, M.D., P.A.
Entity type:Organization
Organization Name:GLENN A. TOVAR DIAS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-275-5934
Mailing Address - Street 1:PO BOX 61570
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-1570
Mailing Address - Country:US
Mailing Address - Phone:239-275-3036
Mailing Address - Fax:239-275-8480
Practice Address - Street 1:14350 METROPOLIS AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4340
Practice Address - Country:US
Practice Address - Phone:239-275-3036
Practice Address - Fax:239-275-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78775207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty