Provider Demographics
NPI:1871996942
Name:GLASS, GERALD GILBERT (PA)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:GILBERT
Last Name:GLASS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:2901 SW 149TH AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4151
Mailing Address - Country:US
Mailing Address - Phone:954-874-4603
Mailing Address - Fax:954-874-3261
Practice Address - Street 1:2901 SW 149TH AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4151
Practice Address - Country:US
Practice Address - Phone:954-874-4603
Practice Address - Fax:954-874-3261
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
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Provider Licenses
StateLicense IDTaxonomies
FLPA3172363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical