Healthcare Provider Details

I. General information

NPI: 1467557884
Provider Name (Legal Business Name): JEROME GREENFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 48TH ST SUITE 2
DES MOINES IA
50310-1988
US

IV. Provider business mailing address

1055 6TH AVE SUITE 200
DES MOINES IA
50314-2607
US

V. Phone/Fax

Practice location:
  • Phone: 515-271-6300
  • Fax:
Mailing address:
  • Phone: 515-643-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28995
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: