Provider Demographics
NPI:1669482543
Name:GRECO, SUSAN NEIMS (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:NEIMS
Last Name:GRECO
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11714 EXMOOR CT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-2911
Mailing Address - Country:US
Mailing Address - Phone:904-997-7166
Mailing Address - Fax:
Practice Address - Street 1:4085 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4357
Practice Address - Country:US
Practice Address - Phone:904-730-0101
Practice Address - Fax:904-730-0121
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074490207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42561Medicare ID - Type Unspecified
FLG63580Medicare UPIN