Individual
JONATHAN K GLAZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3725 11TH CIR, VERO BEACH, FL 32960-4804
(772) 562-0163
(772) 562-1505
Mailing address
3725 11TH CIR, VERO BEACH, FL 32960-4804
(772) 562-0163
(772) 562-1505
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
45283
WI
2085R0202X
Diagnostic Radiology Physician
Primary
ME90452
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270165100
—
FL
01
—
U3695
BLUE CROSS AND BLUE SHIELD OF FLORIDA
FL
Enumeration date
05/23/2005
Last updated
06/12/2024
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