Provider Demographics
NPI:1699716787
Name:GLASS, LEWIS FRANK (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:FRANK
Last Name:GLASS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:LEWIS FRANK
Other - Middle Name:
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 198441
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8441
Mailing Address - Country:US
Mailing Address - Phone:813-745-7365
Mailing Address - Fax:813-449-8618
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-7365
Practice Address - Fax:813-449-8618
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57995207ND0900X, 207N00000X, 207ND0900X
DCMD044262207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064273800Medicaid
FL11312OtherBCBS
FLE66868Medicare UPIN
FL064273800Medicaid
FL11312OtherBCBS