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General NPI Number Information
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NPI Number | 1295123826
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Entity Type | Organization
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Legal Business Name | MONTVERDE MEDICAL CLINIC PA
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Dates
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Enumeration Date | 01/06/2015
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Last Update Date | 01/06/2015
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Provider Practice Location Address
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Address Line | 17434 8TH STREET
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City | MONTVERDE
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State | FL
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Zip | 34756
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Country | US
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Telephone | 386-871-8535
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Fax | 386-269-4328
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Provider Business Mailing Address
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Address Line | 27 RIVER RIDGE TRL
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City | ORMOND BEACH
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State | FL
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Zip | 32174-4341
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Country | US
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Telephone | 386-871-8535
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Fax | 386-269-4328
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. URIL GREENE
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Credential | M.D.
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Telephone | 386-871-8535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | ME92697
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License Number State | FL
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