Provider Demographics
NPI:1619256385
Name:DAVID GREENE MD LLC
Entity Type:Organization
Organization Name:DAVID GREENE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-216-6542
Mailing Address - Street 1:1112 GOODLETTE RD N
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5497
Mailing Address - Country:US
Mailing Address - Phone:239-216-6542
Mailing Address - Fax:239-263-6120
Practice Address - Street 1:1112 GOODLETTE RD N
Practice Address - Street 2:SUITE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5474
Practice Address - Country:US
Practice Address - Phone:239-263-8444
Practice Address - Fax:239-263-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78059207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty