Individual
DR. GLEN R. GOLDFARB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
620 10TH STREET N., ST PETERSBURG, FL 33705-1407
(727) 824-8375
(727) 824-7140
Mailing address
PO BOX 12868, ST PETERSBURG, FL 33733-2868
(727) 824-8357
(727) 824-3132
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
ME66028
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261168600
—
FL
Enumeration date
09/20/2005
Last updated
11/04/2016
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