Healthcare Provider Details

I. General information

NPI: 1396061362
Provider Name (Legal Business Name): SCOTT MICHAEL GREENE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S FORT HARRISON AVE
CLEARWATER FL
33756-3313
US

IV. Provider business mailing address

1330 S FORT HARRISON AVE
CLEARWATER FL
33756-3313
US

V. Phone/Fax

Practice location:
  • Phone: 727-441-3588
  • Fax: 727-461-1038
Mailing address:
  • Phone: 727-441-3588
  • Fax: 727-461-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME123186
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: