Provider Demographics
NPI:1285194068
Name:VAN DER GREEFF, STUART JAMES HUIZENGA
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:JAMES HUIZENGA
Last Name:VAN DER GREEFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STUART
Other - Middle Name:JAMES
Other - Last Name:GREEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1611 NW 12TH AVE # C300
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE # C300
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:303-585-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME165997207L00000X
390200000X
CAA187102207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTRN29121OtherFLORIDA DEPARTMENT OF HEALTH LICENSE NUMBER