Individual
DR. GLENN KEITH MORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO,FACOFP
Contact information
Practice address
201 NW 82ND AVE, PLANTATION, FL 33324-1856
(954) 472-5100
(954) 472-5266
Mailing address
3201 SW 135TH TER, DAVIE, FL 33330-4647
(954) 472-5100
(954) 472-5266
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS5696
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80509
BLUE CROSS BLUE SHIELD
FL
01
—
971681
AETNA
FL
Enumeration date
04/17/2006
Last updated
07/08/2007
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