Healthcare Provider Details

I. General information

NPI: 1982604088
Provider Name (Legal Business Name): JEFFREY GREENSPOON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 REGATTA WAY
BRADENTON FL
34208-8438
US

IV. Provider business mailing address

684 REGATTA WAY
BRADENTON FL
34208-8438
US

V. Phone/Fax

Practice location:
  • Phone: 321-917-7597
  • Fax: 815-346-3305
Mailing address:
  • Phone:
  • Fax: 815-346-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0036832
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME49803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: