| Doctor Name: | GLENN PHAGAN |
| NPI Number: | 1518921378 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D |
| License Number: | ME74781 |
| Business Practice Address: | 1150 N 35th Ave Suite 135 Hollywood, FL - 330215424 |
| Business Phone Number: | 9542656989 |
| Business Fax Number: | 9549653599 |
| Mailing Address: | 1150 N 35th Ave, Suite 135 HOLLYWOOD |
| State: | FL |
| Postal Code: | 330215424 |
| Phone Number: | 9542656989 |
| Fax Number: | 9549653599 |
| NPI Enumeration Date: | 04/17/2006 |
| NPI Last Update Date: | 08/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | ME74781 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |