Healthcare Provider Details

I. General information

NPI: 1902805724
Provider Name (Legal Business Name): BRUCE MYRON GREENFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 SOUTH SIXTH STREET BRAINERD MEDICAL CENTER
BRAINERD MN
56401
US

IV. Provider business mailing address

2024 SOUTH SIXTH STREET BRAINERD MEDICAL CENTER
BRAINERD MN
56401
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-2880
  • Fax: 218-828-7107
Mailing address:
  • Phone: 218-828-2880
  • Fax: 218-828-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number73-125
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: