Provider Demographics
NPI:1467557884
Name:GREENFIELD, JEROME (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:GREENFIELD
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 1:1055 6TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-2607
Mailing Address - Country:US
Mailing Address - Phone:515-643-8672
Mailing Address - Fax:
Practice Address - Street 1:1750 48TH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1988
Practice Address - Country:US
Practice Address - Phone:515-271-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA289952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA21573OtherWELLMARK
IA2091207Medicaid
IAI11406Medicare ID - Type Unspecified
IAE63343Medicare UPIN