Healthcare Provider Details

I. General information

NPI: 1013002526
Provider Name (Legal Business Name): LEE H GREENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 JOG RD. #205
DELRAY BEACH FL
33446
US

IV. Provider business mailing address

15300 JOG RD. #205
DELRAY BEACH FL
33446
US

V. Phone/Fax

Practice location:
  • Phone: 561-496-7200
  • Fax: 561-496-7989
Mailing address:
  • Phone: 561-496-7200
  • Fax: 561-496-7989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0032429
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME105146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: