Provider Demographics
NPI:1215048517
Name:TORRES GLUCK, JOSE ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:TORRES GLUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 917770
Mailing Address - Street 2:WP-522
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:863-603-6542
Mailing Address - Fax:863-603-6529
Practice Address - Street 1:1325 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4544
Practice Address - Country:US
Practice Address - Phone:863-603-6542
Practice Address - Fax:863-603-6529
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME115238207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE008657200Medicaid
FL14P6SOtherBLUE CROSS BLUE SHIELD
NYG07439Medicare UPIN
FL14P6SOtherBLUE CROSS BLUE SHIELD