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DR. GLENN STEVEN AVIDON M.D.

>> Anesthesiology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1124138292

Individual Registrant:
DR. GLENN STEVEN AVIDON M.D.
Gender: M
Not Sole Proprietor

Location and contact information for practice:
368 NE FRANKLIN ST  LAKE CITY, FL 32055-3088 US
Tel: 386-754-8120  Fax: 386-754-8121

Contact information for business:
PO BOX 621749  ORLANDO, FL 32862-1749 US
Tel: 407-468-4301  Fax: 407-880-7901

Registration Information:
NPI: 1124138292
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
FLME 40282
N207L00000XAllopathic & Osteopathic Physicians
Anesthesiology
PAMD423521

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
068418000FL05
103055391PA05




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