Healthcare Provider Details

I. General information

NPI: 1265372668
Provider Name (Legal Business Name): DAVID E GREEN PMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W SYBELIA AVE
MAITLAND FL
32751-4752
US

IV. Provider business mailing address

301 W SYBELIA AVE
MAITLAND FL
32751-4752
US

V. Phone/Fax

Practice location:
  • Phone: 407-766-2708
  • Fax:
Mailing address:
  • Phone: 407-766-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberPMD15355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: