Provider Demographics
NPI:1366527749
Name:GLUSMAN, PAUL JAMES (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:GLUSMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3306
Mailing Address - Country:US
Mailing Address - Phone:954-303-6299
Mailing Address - Fax:954-938-8135
Practice Address - Street 1:5230 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3306
Practice Address - Country:US
Practice Address - Phone:954-303-6299
Practice Address - Fax:954-938-8135
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5529174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE93137Medicare UPIN
FL80131ZMedicare ID - Type Unspecified