MEDICARE: DAVID GREENE MD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	ME78059	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619256385
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID GREENE MD LLC

Provider Business Mailing Address
First Line	:	1112 GOODLETTE RD N
Second Line	:	SUITE 203
City	:	NAPLES
State	:	FL
Zip	:	34102-5497
Country	:	US
Telephone Number	:	239-216-6542
Fax Number	:	239-263-6120

Provider Business Practice Location Address
First Line	:	1112 GOODLETTE RD N
Second Line	:	SUITE 203
City	:	NAPLES
State	:	FL
Zip	:	34102-5474
Country	:	US
Telephone Number	:	239-263-8444
Fax Number	:	239-263-6120

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID GREENE
Credential	:	MD
Telephone Number	:	239-216-6542

Provider Enumeration Date	:	08/11/2011
Last Update Date	:	11/17/2011

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Directions to “DAVID GREENE MD LLC ” Practice Location

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