Individual
DR. JACOB LEON GLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
15730 NEW HAMPSHIRE CT, UNIT 101, FORT MYERS, FL 33908-4121
(239) 561-3430
(239) 561-6980
Mailing address
15730 NEW HAMPSHIRE CT, UNIT 101, FORT MYERS, FL 33908-4121
(239) 561-3430
(239) 561-6980
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0057264
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379285400
—
FL
Enumeration date
03/25/2011
Last updated
03/25/2011
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