Provider Demographics
NPI:1740246180
Name:GREENFIELD, JOHNATHAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNATHAN
Middle Name:C
Last Name:GREENFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20423 STATE ROAD 7
Mailing Address - Street 2:F6-306
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6797
Mailing Address - Country:US
Mailing Address - Phone:561-881-0889
Mailing Address - Fax:561-881-0669
Practice Address - Street 1:2151 45TH ST
Practice Address - Street 2:SUITE 108
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2026
Practice Address - Country:US
Practice Address - Phone:561-881-0889
Practice Address - Fax:561-881-0669
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00813262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264021000Medicaid
FL264021000Medicaid
FL11062Medicare ID - Type Unspecified