Individual
DR. GLENN M BANKERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
550 REDSTONE AVE W, SUITE 470, CRESTVIEW, FL 32536-6428
(850) 689-2223
(850) 689-2204
Mailing address
550 REDSTONE AVE W, SUITE 470, CRESTVIEW, FL 32536-6428
(850) 689-2223
(850) 689-2204
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
OS0005453
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
049359700
—
FL
01
—
593541523
FED TAX IDENTIFICATION
FL
Enumeration date
07/05/2006
Last updated
05/17/2011
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