Individual
DR. GLENN E BURLESON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 W MORENO ST, PENSACOLA, FL 32501-2316
(850) 478-1312
(850) 747-4906
Mailing address
PO BOX 30031, PENSACOLA, FL 32503-1031
(850) 478-1312
(850) 474-9060
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
26708
MN
208600000X
Surgery Physician
Primary
ME95535
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108535
—
AL
05
—
278057700
—
FL
01
—
42054
BLUE CROSS BLUE SHIELD OF FLORIDA
FL
01
—
592-05635
BLUE CROSS BLUE SHIELD OF ALABAMA
AL
Enumeration date
07/13/2006
Last updated
05/11/2010
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