Provider Demographics
NPI:1326157553
Name:BUYO, GLENN M (DO)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:M
Last Name:BUYO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3 W OLIVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2572
Mailing Address - Country:US
Mailing Address - Phone:570-961-9947
Mailing Address - Fax:
Practice Address - Street 1:1500 E HILLSBORO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4348
Practice Address - Country:US
Practice Address - Phone:954-419-9632
Practice Address - Fax:954-419-9334
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2024-11-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101724465Medicaid
PA104842ZFD2Medicare PIN