Individual
GLORIMAR GONZALEZ SAMOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
675 S KINGS AVE STE 101, BRANDON, FL 33511-6048
(813) 588-5123
(863) 646-9664
Mailing address
PO BOX 5618, LAKELAND, FL 33807-5618
(813) 588-5123
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
17491
PR
208D00000X
General Practice Physician
Primary
ACN784
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ACN784
MEDICAL LICENSE NUMBER
FL
Enumeration date
10/09/2009
Last updated
07/12/2023
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