Ebsworth, Gloried Marie

Ebsworth, Gloried Marie is an individual health care provider with primary practice located at 5304 S Florida Ave Ste 400F , Lakeland FL 33813-4914. She recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is her primary health care specialty. Ebsworth, Gloried Marie can be contacted via phone (863) 738-6601.

Contact Information

Primary practice address
5304 S Florida Ave Ste 400F Lakeland FL 33813-4914
Phone: (863) 738-6601
Fax: (863) 937-3002
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X PO 3550 Florida
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X PO 3550 Florida

Profile Details

NPI number 1649408501
LBN Legal business name Ebsworth, Gloried Marie
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 30th, 2009
Last updated Jan 26th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649408501 NPPES
Florida MEDICAID 006315500

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