Provider Demographics
NPI:1861522344
Name:TOBIAS, GLENN T (DO)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:T
Last Name:TOBIAS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6107 BROAD RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:ELLENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34222-7273
Mailing Address - Country:US
Mailing Address - Phone:941-722-4208
Mailing Address - Fax:
Practice Address - Street 1:3420 FRUITVILLE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-9024
Practice Address - Country:US
Practice Address - Phone:941-365-5577
Practice Address - Fax:941-365-1447
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS 00062002083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE45307Medicare UPIN