Provider Demographics
NPI:1831226778
Name:RUSSEL S GLAUN MD PA
Entity type:Organization
Organization Name:RUSSEL S GLAUN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:SELWYN
Authorized Official - Last Name:GLAUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-392-4558
Mailing Address - Street 1:1590 NW 10TH AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-1313
Mailing Address - Country:US
Mailing Address - Phone:561-392-4558
Mailing Address - Fax:561-392-0041
Practice Address - Street 1:1590 NW 10TH AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1313
Practice Address - Country:US
Practice Address - Phone:561-392-4558
Practice Address - Fax:561-392-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70420207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG-27426Medicare UPIN
FL31311AMedicare ID - Type UnspecifiedMEDICARE NUMBER