Provider Demographics
NPI:1235333808
Name:GREIFENKAMP, JONATHAN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:GREIFENKAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19036
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4085
Mailing Address - Country:US
Mailing Address - Phone:903-381-7263
Mailing Address - Fax:903-381-7269
Practice Address - Street 1:709 HOLLYBROOK DR
Practice Address - Street 2:SUITE 2301
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2411
Practice Address - Country:US
Practice Address - Phone:903-757-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6919207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K8162Medicare PIN