Healthcare Provider Details

I. General information

NPI: 1255503363
Provider Name (Legal Business Name): SCOTT M. GREENBERG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24231 WALDEN CENTER DR STE 201
ESTERO FL
34134
US

IV. Provider business mailing address

PO BOX 11390
BELFAST ME
04915-4004
US

V. Phone/Fax

Practice location:
  • Phone: 239-348-4221
  • Fax: 239-390-2486
Mailing address:
  • Phone: 866-949-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS9310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: