Healthcare Provider Details

I. General information

NPI: 1619256385
Provider Name (Legal Business Name): DAVID GREENE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 GOODLETTE RD N SUITE 203
NAPLES FL
34102-5474
US

IV. Provider business mailing address

1112 GOODLETTE RD N SUITE 203
NAPLES FL
34102-5497
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-8444
  • Fax: 239-263-6120
Mailing address:
  • Phone: 239-216-6542
  • Fax: 239-263-6120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberME78059
License Number StateFL

VIII. Authorized Official

Name: DAVID GREENE
Title or Position: OWNER
Credential: MD
Phone: 239-216-6542