Healthcare Provider Details

I. General information

NPI: 1679675235
Provider Name (Legal Business Name): JEFFREY R. GREENFIELD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2006
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 CLEARWATER DRIVE
FALMOUTH ME
04105-8209
US

IV. Provider business mailing address

98 CLEARWATER DRIVE
FALMOUTH ME
04105-8209
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-7900
  • Fax: 707-575-5509
Mailing address:
  • Phone: 207-781-7900
  • Fax: 707-575-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number8555
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number20A13504
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8555
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A13504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: