Organization
PUTNAM E N T PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENWOOD ANTONIO CHARLES MD (PRESIDENT)
(386) 325-1565
Entity
Organization
Contact information
Practice address
320 ZEAGLER DR, STE 1, PALATKA, FL 32177-6851
(386) 325-1565
(386) 325-1571
Mailing address
320 ZEAGLER DR, STE 1, PALATKA, FL 32177-6851
(386) 325-1565
(386) 325-1571
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0050554
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064059000
—
FL
Enumeration date
09/15/2007
Last updated
04/02/2009
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