| Doctor Name: | GLENN WOLFSON |
| NPI Number: | 1609133941 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | ME 56534 |
| Business Practice Address: | 120 Greenhaven Trl Oldsmar, FL - 346774850 |
| Business Phone Number: | 7274603080 |
| Business Fax Number: | |
| Mailing Address: | Po Box 729, OLDSMAR |
| State: | FL |
| Postal Code: | 346770729 |
| Phone Number: | 7274603080 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2012 |
| NPI Last Update Date: | 04/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME 56534 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |