Healthcare Provider Details

I. General information

NPI: 1124278924
Provider Name (Legal Business Name): STUART N GREENBERG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2008
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 E MARION AVE
PUNTA GORDA FL
33950-3819
US

IV. Provider business mailing address

PO BOX 511715
PUNTA GORDA FL
33951-1715
US

V. Phone/Fax

Practice location:
  • Phone: 941-206-5200
  • Fax: 941-206-6418
Mailing address:
  • Phone: 941-206-5200
  • Fax: 941-206-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME93237
License Number StateFL

VIII. Authorized Official

Name: DR. STUART N GREENBERG
Title or Position: OWNER
Credential: MD
Phone: 941-206-5200